Anatomic versus reverse total shoulder replacement for patients with osteoarthritis and intact rotator cuff: the RAPSODI-UK randomised controlled trial protocol

Hannah Rodrick; Joseph Dias; Adam  Watts; Michael Walton; Stephen  Brealey; Richard Page; Nadine E Foster; Katy Boland; Lindsay J Cunningham; John Geoghegan; Greenwood William; Catherine Hewitt; Cliona Kirwan; Matthew Parkes; Steve Parrott; Rachael Powell; Jonathan Quicke; Gareth Roberts; Fiona Rose; Havinder Pal Singh; Helen Spickett; Chris J Sutton; Fraser Wiggins; Qi Wu; Ian Trail

doi:10.1136/bmjopen-2025-106740

Anatomic versus reverse total shoulder replacement for patients with osteoarthritis and intact rotator cuff: the RAPSODI-UK randomised controlled trial protocol

Hannah Rodrick^*
, Joseph Dias
, Adam Watts
, Michael Walton
, Stephen Brealey
, Richard Page
, Nadine E Foster
, Katy Boland
, Lindsay J Cunningham
, John Geoghegan
, Greenwood William
, Catherine Hewitt
, Cliona Kirwan
, Matthew Parkes
, Steve Parrott
, Rachael Powell
, Jonathan Quicke
, Gareth Roberts
, Fiona Rose
, Havinder Pal Singh

Helen Spickett, Chris J Sutton, Fraser Wiggins, Qi Wu, Ian Trail

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

INTRODUCTION: Shoulder osteoarthritis most commonly affects older adults, causing pain, reduced function and quality of life. Total shoulder replacements (TSRs) are indicated once other non-surgical options no longer provide adequate pain relief. Two main types of TSRs are widely used: anatomic TSR (aTSR) and reverse TSR (rTSR). It is not clear whether one TSR type provides better short- or long-term outcomes for patients, and which, if either, is more cost-effective for the National Health Service (NHS).

METHODS AND ANALYSIS: RAPSODI-UK is a multi-centre, pragmatic, two-parallel arm, superiority randomised controlled trial comparing the clinical- and cost-effectiveness of aTSR versus rTSR for adults aged 60+ with a primary diagnosis of osteoarthritis, an intact rotator cuff and bone stock suitable for TSR. Participants in both arms of the trial will receive usual post-operative rehabilitation. We aim to recruit 430 participants from approximately 28 NHS sites across the UK. The primary outcome is the Shoulder Pain and Disability Index (SPADI) at 2 years post-randomisation. Outcomes will be collected at 3, 6, 12, 18 and 24 months after randomisation. Secondary outcomes include the pain and function subscales of the SPADI, the Oxford Shoulder Score, health-related quality of life (EQ-5D-5L), complications, range of movement and strength, revisions and mortality. The between-group difference in the primary outcome will be derived from a constrained longitudinal data analysis model. We will also undertake a full health economic evaluation and conduct qualitative interviews to explore perceptions of acceptability of the two types of TSR and experiences of recovery with a sample of participants.

ETHICS AND DISSEMINATION: Ethics committee approval for this trial was obtained (London - Queen Square Research Ethics Committee, Rec Reference 22/LO/0617) on 4 October 2022. The results of the main trial will be submitted for publication in a peer-reviewed journal and using other professional and media outlets.

TRIAL REGISTRATION NUMBER: ISRCTN12216466.

Original language	English
Pages (from-to)	e106740
Journal	BMJ Open
Volume	15
Issue number	12
DOIs	https://doi.org/10.1136/bmjopen-2025-106740
Publication status	Published - 12 Dec 2025

Keywords

Aged
Female
Humans
Male
Middle Aged
Arthroplasty, Replacement, Shoulder/methods
Cost-Benefit Analysis
Multicenter Studies as Topic
Osteoarthritis/surgery
Quality of Life
Rotator Cuff/surgery
Shoulder Joint/surgery
Treatment Outcome
United Kingdom
Pragmatic Clinical Trials as Topic
Equivalence Trials as Topic

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10.1136/bmjopen-2025-106740Licence: CC BY

(MCHP) : Manchester Centre for Health Psychology
Peters, S. (PI), Ulph, F. (PI), Arden Armitage, C. (Researcher), Borrelli, B. (Researcher), Bowen, A. (Researcher), Byrne-Davis, L. (Researcher), Edge, D. (Researcher), French, D. (Researcher), Hart, J. (Researcher), Todd, C. (Researcher), Skevington, S. (Researcher), Wearden, A. (Researcher), Cotterill, S. (Researcher), Brooks, J. (Researcher), Brown, L. (Researcher), Bull, E. (Researcher), Cordingley, L. (Researcher), Epton, T. (Researcher), Smith, D. (Researcher), Speer, S. (Researcher), Powell, R. (Researcher), Bartlett, K. (Researcher), Coupe, N. (Researcher), Shepherd, S. (Researcher), Dienes, K. (Researcher), Ghio, D. (Researcher), Hood, A. (Researcher), Lavallee, J. (Researcher), Rowland, C. (Researcher), Benton, J. (Researcher), Goldthorpe, J. (Researcher), McWilliams, L. (Researcher), Keyworth, C. (Researcher), Goulding, R. (Researcher), Loughran, M. (Researcher), Hawkes, R. (Researcher), Kapadi, A. (Researcher), Hurley, R. (Researcher), Leather, J. (Researcher), Musa, C. (Researcher), Angelakis, I. (Researcher), Reid, C. (Researcher), Reid, H. (PGR student), Hulme, L. (PGR student), Hindmarch, S. (PGR student), Plant, S. (Researcher), Peterson, J. (Researcher), Woof, V. (PGR student), Devereux-Fitzgerald, A. (Researcher), Sawyer, C. (Researcher), Wilkes, J. (Researcher), Birtwell, K. (Researcher), Stringer, G. (Researcher), Tang, M. Y. (Researcher), Coupe, N. (Researcher), Hamnett, C. (Support team), Lyons, S. (Researcher), Hulme, L. (PGR student) & Lee, R. (Researcher)
1/09/10 → …
Project: Research

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Rodrick, H., Dias, J., Watts, A., Walton, M., Brealey, S., Page, R., Foster, N. E., Boland, K., Cunningham, L. J., Geoghegan, J., William, G., Hewitt, C., Kirwan, C., Parkes, M., Parrott, S., Powell, R., Quicke, J., Roberts, G., Rose, F., ... Trail, I. (2025). Anatomic versus reverse total shoulder replacement for patients with osteoarthritis and intact rotator cuff: the RAPSODI-UK randomised controlled trial protocol. BMJ Open, 15(12), e106740. https://doi.org/10.1136/bmjopen-2025-106740

@article{764eabe7ae894d26b9a3fe7248d113ef,

title = "Anatomic versus reverse total shoulder replacement for patients with osteoarthritis and intact rotator cuff: the RAPSODI-UK randomised controlled trial protocol",

abstract = "INTRODUCTION: Shoulder osteoarthritis most commonly affects older adults, causing pain, reduced function and quality of life. Total shoulder replacements (TSRs) are indicated once other non-surgical options no longer provide adequate pain relief. Two main types of TSRs are widely used: anatomic TSR (aTSR) and reverse TSR (rTSR). It is not clear whether one TSR type provides better short- or long-term outcomes for patients, and which, if either, is more cost-effective for the National Health Service (NHS).METHODS AND ANALYSIS: RAPSODI-UK is a multi-centre, pragmatic, two-parallel arm, superiority randomised controlled trial comparing the clinical- and cost-effectiveness of aTSR versus rTSR for adults aged 60+ with a primary diagnosis of osteoarthritis, an intact rotator cuff and bone stock suitable for TSR. Participants in both arms of the trial will receive usual post-operative rehabilitation. We aim to recruit 430 participants from approximately 28 NHS sites across the UK. The primary outcome is the Shoulder Pain and Disability Index (SPADI) at 2 years post-randomisation. Outcomes will be collected at 3, 6, 12, 18 and 24 months after randomisation. Secondary outcomes include the pain and function subscales of the SPADI, the Oxford Shoulder Score, health-related quality of life (EQ-5D-5L), complications, range of movement and strength, revisions and mortality. The between-group difference in the primary outcome will be derived from a constrained longitudinal data analysis model. We will also undertake a full health economic evaluation and conduct qualitative interviews to explore perceptions of acceptability of the two types of TSR and experiences of recovery with a sample of participants.ETHICS AND DISSEMINATION: Ethics committee approval for this trial was obtained (London - Queen Square Research Ethics Committee, Rec Reference 22/LO/0617) on 4 October 2022. The results of the main trial will be submitted for publication in a peer-reviewed journal and using other professional and media outlets.TRIAL REGISTRATION NUMBER: ISRCTN12216466.",

keywords = "Aged, Female, Humans, Male, Middle Aged, Arthroplasty, Replacement, Shoulder/methods, Cost-Benefit Analysis, Multicenter Studies as Topic, Osteoarthritis/surgery, Quality of Life, Rotator Cuff/surgery, Shoulder Joint/surgery, Treatment Outcome, United Kingdom, Pragmatic Clinical Trials as Topic, Equivalence Trials as Topic",

author = "Hannah Rodrick and Joseph Dias and Adam Watts and Michael Walton and Stephen Brealey and Richard Page and Foster, \{Nadine E\} and Katy Boland and Cunningham, \{Lindsay J\} and John Geoghegan and Greenwood William and Catherine Hewitt and Cliona Kirwan and Matthew Parkes and Steve Parrott and Rachael Powell and Jonathan Quicke and Gareth Roberts and Fiona Rose and Singh, \{Havinder Pal\} and Helen Spickett and Sutton, \{Chris J\} and Fraser Wiggins and Qi Wu and Ian Trail",

note = "{\textcopyright} Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.",

year = "2025",

month = dec,

day = "12",

doi = "10.1136/bmjopen-2025-106740",

language = "English",

volume = "15",

pages = "e106740",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ ",

number = "12",

}

Rodrick, H, Dias, J, Watts, A, Walton, M, Brealey, S, Page, R, Foster, NE, Boland, K, Cunningham, LJ, Geoghegan, J, William, G, Hewitt, C, Kirwan, C , Parkes, M, Parrott, S, Powell, R, Quicke, J, Roberts, G, Rose, F, Singh, HP, Spickett, H, Sutton, CJ, Wiggins, F, Wu, Q & Trail, I 2025, 'Anatomic versus reverse total shoulder replacement for patients with osteoarthritis and intact rotator cuff: the RAPSODI-UK randomised controlled trial protocol', BMJ Open, vol. 15, no. 12, pp. e106740. https://doi.org/10.1136/bmjopen-2025-106740

TY - JOUR

T1 - Anatomic versus reverse total shoulder replacement for patients with osteoarthritis and intact rotator cuff

T2 - the RAPSODI-UK randomised controlled trial protocol

AU - Rodrick, Hannah

AU - Dias, Joseph

AU - Watts, Adam

AU - Walton, Michael

AU - Brealey, Stephen

AU - Page, Richard

AU - Foster, Nadine E

AU - Boland, Katy

AU - Cunningham, Lindsay J

AU - Geoghegan, John

AU - William, Greenwood

AU - Hewitt, Catherine

AU - Kirwan, Cliona

AU - Parkes, Matthew

AU - Parrott, Steve

AU - Powell, Rachael

AU - Quicke, Jonathan

AU - Roberts, Gareth

AU - Rose, Fiona

AU - Singh, Havinder Pal

AU - Spickett, Helen

AU - Sutton, Chris J

AU - Wiggins, Fraser

AU - Wu, Qi

AU - Trail, Ian

N1 - © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.

PY - 2025/12/12

Y1 - 2025/12/12

N2 - INTRODUCTION: Shoulder osteoarthritis most commonly affects older adults, causing pain, reduced function and quality of life. Total shoulder replacements (TSRs) are indicated once other non-surgical options no longer provide adequate pain relief. Two main types of TSRs are widely used: anatomic TSR (aTSR) and reverse TSR (rTSR). It is not clear whether one TSR type provides better short- or long-term outcomes for patients, and which, if either, is more cost-effective for the National Health Service (NHS).METHODS AND ANALYSIS: RAPSODI-UK is a multi-centre, pragmatic, two-parallel arm, superiority randomised controlled trial comparing the clinical- and cost-effectiveness of aTSR versus rTSR for adults aged 60+ with a primary diagnosis of osteoarthritis, an intact rotator cuff and bone stock suitable for TSR. Participants in both arms of the trial will receive usual post-operative rehabilitation. We aim to recruit 430 participants from approximately 28 NHS sites across the UK. The primary outcome is the Shoulder Pain and Disability Index (SPADI) at 2 years post-randomisation. Outcomes will be collected at 3, 6, 12, 18 and 24 months after randomisation. Secondary outcomes include the pain and function subscales of the SPADI, the Oxford Shoulder Score, health-related quality of life (EQ-5D-5L), complications, range of movement and strength, revisions and mortality. The between-group difference in the primary outcome will be derived from a constrained longitudinal data analysis model. We will also undertake a full health economic evaluation and conduct qualitative interviews to explore perceptions of acceptability of the two types of TSR and experiences of recovery with a sample of participants.ETHICS AND DISSEMINATION: Ethics committee approval for this trial was obtained (London - Queen Square Research Ethics Committee, Rec Reference 22/LO/0617) on 4 October 2022. The results of the main trial will be submitted for publication in a peer-reviewed journal and using other professional and media outlets.TRIAL REGISTRATION NUMBER: ISRCTN12216466.

AB - INTRODUCTION: Shoulder osteoarthritis most commonly affects older adults, causing pain, reduced function and quality of life. Total shoulder replacements (TSRs) are indicated once other non-surgical options no longer provide adequate pain relief. Two main types of TSRs are widely used: anatomic TSR (aTSR) and reverse TSR (rTSR). It is not clear whether one TSR type provides better short- or long-term outcomes for patients, and which, if either, is more cost-effective for the National Health Service (NHS).METHODS AND ANALYSIS: RAPSODI-UK is a multi-centre, pragmatic, two-parallel arm, superiority randomised controlled trial comparing the clinical- and cost-effectiveness of aTSR versus rTSR for adults aged 60+ with a primary diagnosis of osteoarthritis, an intact rotator cuff and bone stock suitable for TSR. Participants in both arms of the trial will receive usual post-operative rehabilitation. We aim to recruit 430 participants from approximately 28 NHS sites across the UK. The primary outcome is the Shoulder Pain and Disability Index (SPADI) at 2 years post-randomisation. Outcomes will be collected at 3, 6, 12, 18 and 24 months after randomisation. Secondary outcomes include the pain and function subscales of the SPADI, the Oxford Shoulder Score, health-related quality of life (EQ-5D-5L), complications, range of movement and strength, revisions and mortality. The between-group difference in the primary outcome will be derived from a constrained longitudinal data analysis model. We will also undertake a full health economic evaluation and conduct qualitative interviews to explore perceptions of acceptability of the two types of TSR and experiences of recovery with a sample of participants.ETHICS AND DISSEMINATION: Ethics committee approval for this trial was obtained (London - Queen Square Research Ethics Committee, Rec Reference 22/LO/0617) on 4 October 2022. The results of the main trial will be submitted for publication in a peer-reviewed journal and using other professional and media outlets.TRIAL REGISTRATION NUMBER: ISRCTN12216466.

KW - Aged

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Arthroplasty, Replacement, Shoulder/methods

KW - Cost-Benefit Analysis

KW - Multicenter Studies as Topic

KW - Osteoarthritis/surgery

KW - Quality of Life

KW - Rotator Cuff/surgery

KW - Shoulder Joint/surgery

KW - Treatment Outcome

KW - United Kingdom

KW - Pragmatic Clinical Trials as Topic

KW - Equivalence Trials as Topic

U2 - 10.1136/bmjopen-2025-106740

DO - 10.1136/bmjopen-2025-106740

M3 - Article

C2 - 41386993

SN - 2044-6055

VL - 15

SP - e106740

JO - BMJ Open

JF - BMJ Open

IS - 12

ER -

Anatomic versus reverse total shoulder replacement for patients with osteoarthritis and intact rotator cuff: the RAPSODI-UK randomised controlled trial protocol

Abstract

Keywords

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