Glenohumeral arthritis in the young, active patient represents a clinical challenge for the treating physician because of these patients’ higher functional demands and their need to maintain a functional shoulder for many additional decades of life. Nonsurgical treatment followed by joint-sparing or joint-preserving surgical procedures should be pursued whenever possible. Such surgical treatment options include débridement, capsular release, microfracture, autologous chondrocyte implantation, and osteochondral allograft techniques. When joint replacement is needed, partial resurfacing or bone-preserving procedures may offer effective solutions. When complete humeral and/or glenoid replacement is required, careful decisions about expectations and functional requirements are needed, and alternative bearing surfaces can be considered.