Anatomic versus reverse total shoulder replacement for patients with osteoarthritis and intact rotator cuff: the...

Area of Science:

• Orthopedics
• Clinical Trials
• Health Economics

Background:

• Shoulder osteoarthritis significantly impacts older adults, causing pain and reduced quality of life.
• Total shoulder replacements (TSRs) are surgical options when conservative treatments fail.
• Anatomic (aTSR) and reverse (rTSR) total shoulder replacements are common, but their comparative effectiveness and cost-effectiveness remain unclear.

Purpose of the Study:

• To compare the clinical and cost-effectiveness of aTSR versus rTSR in adults aged 60+ with shoulder osteoarthritis.
• To determine if one type of TSR provides superior short- or long-term outcomes.
• To assess the cost-effectiveness of each TSR type for the National Health Service (NHS).

Main Methods:

• A multi-centre, pragmatic, superiority randomised controlled trial (RAPSODI-UK) involving 430 participants.
• Comparison of aTSR versus rTSR in patients with primary osteoarthritis, intact rotator cuff, and suitable bone stock.
• Primary outcome: Shoulder Pain and Disability Index (SPADI) at 2 years. Secondary outcomes include pain, function, quality of life, complications, and range of motion.

Main Results:

• Data collection ongoing, primary outcome at 2 years post-randomisation.
• Full health economic evaluation and qualitative interviews will be conducted.
• Results will be published in peer-reviewed journals and disseminated through professional and media outlets.

Conclusions:

• The RAPSODI-UK trial will provide crucial evidence on the comparative effectiveness and cost-effectiveness of aTSR and rTSR.
• Findings will inform clinical decision-making and healthcare policy regarding shoulder replacement surgery.
• The study aims to optimize treatment strategies for shoulder osteoarthritis in the UK population.