Shoulder resurfacing is a versatile, bone conserving procedure for treating arthritis, avascular necrosis, and rotator cuff arthropathy. Shoulder resurfacing is of interest to young patients who are concerned about implant survivorship and those in need of a high level of physical activity. Using a ceramic surface reduces wear and metal sensitivity to clinically unimportant levels. 586 patients received cementless, ceramic coated shoulder resurfacing implants. They were followed for 11 years and 94% achieved good or excellent results. 86% of patients preferred shoulder resurfacing compared to stemmed or stem supported shoulder replacement. Shoulder resurfacing had a much lower revision and complication rate compared to conventional or reverse total shoulder replacement.