Six professional wrestling matches were featured on the event's supercard, a scheduling of more than one main event. The primary match on the SmackDown! brand was Kurt Angle versus Mark Henry for the World Heavyweight Championship, which Angle won after pinning Henry with a roll-up. The predominant match on the Raw brand was Edge versus John Cena for the WWE Championship, which Cena won after forcing Edge to submit to the STFU. The featured match on the undercard was the annual 30-man Royal Rumble match, which featured wrestlers from both brands. Rey Mysterio, the second entrant, won the match by last eliminating Randy Orton, the thirtieth entrant.
Royal Rumble featured professional wrestling matches that involved different wrestlers from pre-existing scripted feuds, plots, and storylines that were played out on Raw and SmackDown! – World Wrestling Entertainment's (WWE) primary television programs. Wrestlers portrayed a villain or a hero as they followed a series of events that built tension, and culminated into a wrestling match or series of matches. The event featured wrestlers from WWE's Raw and SmackDown! brands – a storyline division in which WWE employees were assigned to a television program of the same name.
The main feud heading into the Royal Rumble on the Raw was between Edge and John Cena, with the two feuding over the WWE Championship. The feud started at New Year's Revolution when Cena won an Elimination Chamber also involving 5 other superstars. Immediately after the match, however, Vince McMahon came out and stated that Edge was cashing in his Money in the Bank contract that he won at WrestleMania 21. Edge then came out with Lita and, two spears later, he pinned Cena to become WWE Champion. Then the next night, Edge held a live sex celebration which got smashed up by Cena and Cena delivered an FU on Lita and sent a message to Edge.
The main feud heading into the Royal Rumble on the Smackdown! brand was between Kurt Angle and Mark Henry over the World Heavyweight Championship. The World Heavyweight Championship was originally held by Batista. He defended the title against Henry at a SmackDown!live event in a steel cage match. Henry was disqualified in the match and Batista retained the title but his triceps were injured. As a result, he was forced to vacate the title on the January 13 episode of SmackDown!. Later on, a 20-man battle royal was arranged to determine the new World Heavyweight Champion. Rawsuperstar Kurt Angle won the battle royal last eliminating Mark Henry and winning the vacant title thus also starting a rivalry between the two. This also made Angle leave Raw and move to SmackDown!. The next week, Henry defeated Rey Mysterio to become the Number One Contender to Angle's title.