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The radiograph shows superior migration of the humeral head with significant glenohumeral degenerative joint disease suggestive of rotator cuff arthropathy. Rotator cuff arthropathy is characterized by bony erosion, superior migration of the humeral head, and erosion of the acromion and acromioclavicular joint. The results of total shoulder arthroplasty performed as management for rotator cuff arthropathy had been disappointing due to poor function, continued superior migration, and glenoid component loosening ("rocking horse" phenomenon). Two better options are humeral head replacement (hemiarthroplasty) or reverse total shoulder arthroplasty (R-TSA). Hemiarthroplasty was a popular choice prior to the development of the reverse. Zuckerman et al showed improved pain scores and mild functional improvements in a small case series. Leung recently showed better results for the R-TSA than for hemi in their patients. A hemiarthroplasty may still be preferred if their is insufficient glenoid bone stock or poorly functioning deltoid which you cannot rule out based on this single radiograph. Gerber discusses the development of the R-TSA but notes that it has a significantly higher complication rate than conventional arthroplasty.