Purpose <p>Management of blood transfusion in the peri-operative period of joint arthroplasties is often difficult and although associated risk factors and practice trends help ease this process, for shoulder arthroplasty, these aspects have not been explored as widely as other procedures. The purposes of the current study were to identify the incidence, risk factors and trends of blood transfusion in shoulder arthroplasty patients over a 25-year period in a single, high-volume centre.</p> Methods <p>We retrospectively reviewed all patients undergoing hemi-, total and reverse shoulder arthroplasties, including revision procedures, between 1997 and 2021. Overall rate of blood transfusion, procedure and patient related risk factors, and transfusion trends over time were evaluated.</p> Results <p>A total of 3,168 patients were included in the analysis and overall rate of blood transfusion was 1.8%. Multivariate analysis revealed revision procedure (<i>p</i> &lt; 0.001), prior revision (<i>p</i> = 0.035), regional anaesthesia (<i>p</i> = 0.004), history of hypertension (<i>p</i> = 0.043), history of myocardial infarction (<i>p</i> = 0.004), history of renal insufficiency (<i>p</i> = 0.045), and alcohol abuse (<i>p</i> = 0.033) were independent risk factors for transfusion. Although transfusion rates were observed to be increased after 2007, from 0.6 to 0.8 to over 2%, this trend did not demonstrate statistical significance.</p> Conclusion <p>Revision procedures and regional anaesthesia as well as hypertension, myocardial infarction, renal insufficiency and alcohol abuse can be regarded as independent risk factors for blood transfusion in shoulder arthroplasty. It is imperative to implement advanced blood conservation protocols for patients with these risk factors.</p>