Introduction <p>This study aimed to compare the clinical outcomes of cemented versus cementless reverse total shoulder arthroplasty (rTSA) for the treatment of proximal humeral fractures (PHFs), with a focus on revision rates, tuberosity union, scapular notching, range of motion, and functional scores.</p> Materials and methods <p>A systematic review and meta-analysis were conducted, incorporating data from studies comparing cemented and cementless rTSA for PHFs. Key outcomes analyzed included revision rates, tuberosity union rates, scapular notching, range of motion, and functional scores.</p> Results <p>The analysis included data from seven studies, encompassing a total of 6,692 cases. Cementless rTSA demonstrated a statistically significant higher overall revision rate compared to cemented rTSA, with revision rates of 5.5% and 4.1%, respectively. Tuberosity union rates were 62.4% for the cemented group and 69.3% for the cementless group. Scapular notching was observed in 12.8% of the cemented group and 7.5% of the cementless group, although this difference was not statistically significant. Importantly, clinical outcomes such as Constant, American Shoulder and Elbow Surgeons scores and range of motion showed no statistically significant differences between the two groups.</p> Conclusions <p>Cementless rTSA has a statistically significantly higher overall revision rate compared to cemented rTSA. Despite this, both fixation methods provide similar clinical outcomes for PHFs, including tuberosity union, scapular notching, range of motion, and functional scores.</p>