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Why would they not do a shoulder replacement for someone with a bad rotator cuff injury?

Joint replacements are a major surgery that involves a lot of recovery and rehabilitation. At this point, the surgery is usually done for people who have problems with the joint itself, not the surrounding tissues.

Treatment for a rotator cuff injury begins with non-surgical treatment, which involves physiotherapy, medications for the pain and inflammation, and perhaps injections of corticosteroids into the area. If this doesn't work, then surgery may be needed to repair the tendons. This type of surgery has a good success rate and after recovery, the patients are usually happy with the results.

Reference: 

Matthias A. Zumstein, MD et al. The Clinical and Structural Long-Term Results of Open Repair of Massive Tears of the Rotator Cuff. In The Journal of Bone & Joint Surgery. November 2008. Vol. 90. No. 11.

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