It is unclear whether hemiarthroplasty (HA) or reverse shoulder arthroplasty (RS) are superior for patients with cuff tear arthropathy (CTA) and preserved preoperative motion (elevation >90˚). Patients who underwent RSA or HA for CTA at one institution were included if they had preserved preoperative motion with a minimum of 2 years of followup, or until complication/revision. Shoulder ROM and functional outcomes scores were obtained. Twenty-six HAs and 21 RSAs were evaluated at mean of 38.6 months (HA) and 36.3 months (RSA). Patients in the RSA group were significantly older at surgery (73.9 versus 65.1 years; p=0.003). Postoperatively, the mean change in active elevation was -15° for HA versus 26° for RSA, with RSA having significantly greater active elevation (153° versus 123°; p=0.01). There were no significant differences in final internal or external rotation between groups. Superior outcomes were seen for RSA versus HA for ASES score (84 vs. 66, p=0.003), Simple Shoulder Test (8.8 vs. 7.3, p=0.3), Single Assessment Numeric Evaluation (85 vs. 70, p=0.017), and 100mm VAS pain (7 vs. 33, p<0.001). In patients with CTA and preserved preoperative forward elevation, RSA provided greater pain relief, superior functional outcomes, and better ROM compared with HA.