For most patients with advanced glenohumeral osteoarthritis (OA), primary total shoulder arthroplasty (TSA) provides the most predictable outcome. Over the past decade, the role of primary TSA in young, active patients with glenohumeral OA has been questioned because of high rates of early glenoid component loosening that requires subsequent revision TSA. As a result, arthroscopic and other non-arthroplasty alternatives have been used as joint-preservation strategies. Such approaches can serve as bridging procedures with palliation of pain and delay the need for primary TSA in younger patients. However, comparisons of the potential benefits between arthroscopic management (AM) and primary TSA have not been performed. Therefore the purposes of this study were (1) to construct a theoretical decision model based on published literature to compare the total remaining quality-adjusted life-years (QALYs) between AM and TSA treatment strategies and (2) to determine the effects of age on the preferred treatment strategy. We hypothesized that AM would provide an increase in the total remaining QALYs when compared with TSA for patients younger than 50 years.