Reverse total shoulder arthroplasty (RTSA) has expanded dramatically as surgeons refine indications and understand its biomechanical advantages. This conversation traces its evolution from early constrained designs to the modern Grammont and lateralized philosophies, highlighting why RTSA now outpaces anatomic arthroplasty in complex cases—especially those with glenoid bone loss, cuff insufficiency, or instability. Technical demands, complication patterns, and the shifting learning curve are explored alongside emerging research needs, particularly in cuff-intact osteoarthritis. The episode also personalizes the discussion through reflections on academic impact and the value of maintaining creativity and balance beyond the operating room.