Anatomic total shoulder arthroplasty is an effective procedure in the treatment of a wide range of shoulder pathologies. It provides a significant pain reduction and restoration of shoulder function guaranteed by a restoration of the articular anatomy and a proper preservation of soft tissues integrity and activity. Thanks to the increasing knowledge about shoulder anatomy and technical improvements, new generations of prosthetic models have been released, capable of adapting to the patient’s anatomy. Despite its use being restricted by the advent of the reverse shoulder arthroplasty, it retains peculiar and precise indications: concentric osteoarthritis, avascular necrosis, shoulder fractures and their sequelae, rheumatoid arthritis and inflammatory arthritis and instability arthropathy. Given the right indication, it provides satisfactory and reproducible results, even superior to those of the reverse shoulder arthroplasty.