Recently, indications for reverse total shoulder arthroplasty have expanded to include glenohumeral arthritis, rotator cuff arthropathy, irreparable rotator cuff tears, complex proximal humerus fractures, sequelae of trauma, and failed shoulder prostheses. Dislocation is a common complication, with rates ranging from 1.5% to 31%. The literature pertaining to management of instability in reverse total shoulder arthroplasty is scanty. Assessment of the patient and biomechanical and surgical factors is critical in determining the best course of treatment. Future studies involving patient selection, prosthetic design, surgical technique, and biomechanics may help reduce the rate of instability.