In the normal glenohumeral joint, the humeral head and the glenoid articulate via smooth and congruent articular surfaces. In the osteoarthritic shoulder, however, both the articular surface anatomy and orientation may be severely distorted and the soft tissues grossly contracted, leading to pain and loss of function. While replacement arthroplasty is the treatment of choice in the elderly, therapeutic options for young active patients include conservative treatment, arthroplasty, and corrective osteotomy and are directed, whenever possible, toward joint preservation.