To assess the outcome of a short metaphyseal rTSA in patients aged 65 or younger Reverse total shoulder arthroplasty (rTSA) are increasingly used in recent years for treatment of glenohumeral arthropathy with deficient rotator cuff. Bone preservation is becoming a major goal in shoulder replacement surgery, especially in young patients. Metaphyseal humeral components without a stem were developed to minimize bone resection and preserve bone. We evaluated 44 patients (29 F, 15 M) with a mean age of 59 years (range, 33-65 years) that underwent metaphyseal rTSA between 2006 - 2015. 17 were revisions. Indications were cuff tear artropathy, rheumathoid arthritis, primary ostheoarthritis and fracture sequelae. Constant Score (CS), Pain score, Subjective Shoulder Value (SSV) and patients’ satisfaction were used preoperatively and postoperatively with mean follow up 49 ± 25.7 months. Mean CS improved from 18.1±11.9 to 60.1±18.6 (p<0.001) (Age/sex adjusted to 83.5 ± 25.2). Pain score improved from 3.5/15 to 11.1/15. Mean active elevation 141.1°±41.9° (p<0.001), active abduction 136.8°±44.7° (p<0.001) , active external rotation 36.9°±21.4° (p<0.001) and active internal rotation 66.2°±23.1° (p<0.001). All the patients rated their shoulder as much better or better, with 68% excellent. There were no statistically significant differences between outcomes at 12 months and the last follow up; however, some further improvements were seen in almost all shoulders with time. No differences were observed between primary and revision cases. No lucencies, loosening, subsidence or stress shielding were evident radiographically. One case of grade-2 glenoid notching. 2 cases had postoperative complications. rTSA can be used with good results and high satisfaction in patients aged 65 years or younger. The use of a short metaphyseal implant that preserves the bone, allows its use in young patients as all options are preserved if any future surgeries will be needed. Good clinical and radiological results are maintained over time.