Regional Trends and Variation in Knee Osteotomy Surgery in England, UK: A Longitudinal Analysis of National Health Service Data over Twenty Years
5 affiliations
- 1Musculoskeletal Research Unit, University of Bristol, Bristol, United Kingdom
- 2Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- 3Department of Trauma and Orthopaedics, North Bristol NHS Trust, Bristol, United Kingdom
- 4Department of Trauma and Orthopaedics, Liverpool University Hospitals Foundation Trust, Liverpool, United Kingdom
- 5Department of Trauma & Orthopaedic Surgery, University of Manchester, Manchester, United Kingdom
Abstract
Aims: Knee osteotomy is an established joint preserving procedure; however, despite expanding indications and training, national utilisation patterns remain poorly characterized. We investigated long-term temporal trends and geographic variation in the provision of high tibial (HTO) and distal femoral osteotomy (DFO) across the National Health Service (NHS) in England.
Methods: We conducted a retrospective national epidemiological study using NHS Hospital Episode Statistics (HES). All episodes for patients aged 16–80 undergoing knee osteotomy (excluding patellofemoral) between Jan 1, 2002, and Dec 31, 2022, were extracted. Age- and sex-standardised intervention rates were calculated using Office for National Statistics population data. Trends were analysed nationally and regionally by Integrated Care Board (ICB) to determine geographic variation in service provision.
Results: We identified 24,516 cases (22,900 patients) meeting inclusion criteria. The national standardised intervention rate increased by over 300% during the study period, rising from 1.3/100,000 in 2002 to 3.9/100,000 in 2022 (peaking at 5.1/100,000 in 2019). HTO accounted for 71.16% of procedures, and males comprised 60.9% of the cohort. In 2022, intervention rates were highest in the 16–19 (7.3/100,000) and 40–59 (4.8/100,000) age groups. Substantial regional disparity was detected, with a near ten-fold variation in 2022 intervention rates between ICB regions (range: 1.0 to 9.5 per 100,000).
Conclusion: Knee osteotomy utilisation has risen significantly in England, reflecting the growing role of this joint preserving surgery. However, the extreme regional variation suggests a significant potential inequity in access to joint-preservation surgery. These findings highlight an urgent need for the development of standardised treatment guidance and a review of service provision to ensure patients have access to the procedure when indicated.
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BibTeX
@article{hennessy2026regional,
title = {{Regional Trends and Variation in Knee Osteotomy Surgery in England, UK: A Longitudinal Analysis of National Health Service Data over Twenty Years}},
author = {Conor Hennessy and Nick Howells and Michael McNicholas and Leela Biant and Simon G.F. Abram},
journal = {Cartilage},
year = {2026},
month = nov,
doi = {10.1177/19476035261498345},
url = {https://doi.org/10.1177/19476035261498345},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Regional Trends and Variation in Knee Osteotomy Surgery in England, UK: A Longitudinal Analysis of National Health Service Data over Twenty Years
AU - Conor Hennessy
AU - Nick Howells
AU - Michael McNicholas
AU - Leela Biant
AU - Simon G.F. Abram
PY - 2026
DA - 2026/11/04
JO - Cartilage
DO - 10.1177/19476035261498345
UR - https://doi.org/10.1177/19476035261498345
AB - Aims: Knee osteotomy is an established joint preserving procedure; however, despite expanding indications and training, national utilisation patterns remain poorly characterized. We investigated long-term temporal trends and geographic variation in the provision of high tibial (HTO) and distal femoral osteotomy (DFO) across the National Health Service (NHS) in England. Methods: We conducted a retrospective national epidemiological study using NHS Hospital Episode Statistics (HES). All episodes for patients aged 16–80 undergoing knee osteotomy (excluding patellofemoral) between Jan 1, 2002, and Dec 31, 2022, were extracted. Age- and sex-standardised intervention rates were calculated using Office for National Statistics population data. Trends were analysed nationally and regionally by Integrated Care Board (ICB) to determine geographic variation in service provision. Results: We identified 24,516 cases (22,900 patients) meeting inclusion criteria. The national standardised intervention rate increased by over 300% during the study period, rising from 1.3/100,000 in 2002 to 3.9/100,000 in 2022 (peaking at 5.1/100,000 in 2019). HTO accounted for 71.16% of procedures, and males comprised 60.9% of the cohort. In 2022, intervention rates were highest in the 16–19 (7.3/100,000) and 40–59 (4.8/100,000) age groups. Substantial regional disparity was detected, with a near ten-fold variation in 2022 intervention rates between ICB regions (range: 1.0 to 9.5 per 100,000). Conclusion: Knee osteotomy utilisation has risen significantly in England, reflecting the growing role of this joint preserving surgery. However, the extreme regional variation suggests a significant potential inequity in access to joint-preservation surgery. These findings highlight an urgent need for the development of standardised treatment guidance and a review of service provision to ensure patients have access to the procedure when indicated.
SN - 1947-6035
SN - 1947-6043
ER -