Ankle arthrodesis and total ankle replacement – Variations in surgical practice across England using Hospital Episode Statistics database
6 affiliations
- 1Getting It Right First Time Programme, NHS England, London, United Kingdom
- 2Trauma and Orthopaedic Department, North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Sheilds, United Kingdom
- 3Hull York Medical School, University of York, Heslington, York, United Kingdom
- 4Trauma and Orthopaedic Department, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
- 5Trauma and Orthopaedic Department, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
- 6Trauma and Orthopaedic Department, Royal National Orthopaedic Hospital, Royal National Orthopaedic Hospitals Trust, Stanmore, London, United Kingdom
Abstract
Background and Purpose: End stage ankle arthritis can be managed surgically by ankle arthrodesis or total ankle replacement. Not all surgeons perform both ankle arthrodesis and total ankle replacement. This study aims to determine the numbers of ankle arthrodesis and ankle replacements being performed throughout England and to analyse variation in provision. Methods: This is a retrospective study using Hospital Episode Statistics data from NHS England for the period April 2013 to March 2025 categorised geographically by Integrated Care Boards (ICB) and NHS England regions and over time by financial year. Results: A total of 26,331 procedures were performed for end stage ankle arthritis. There was variation between ICBs with regards to the proportion of ankle replacements and ankle arthrodesis being performed. Over the study period, most practices changed towards an increasing proportion of ankle replacements. Patients receiving ankle replacements travelled further for their operation compared to those receiving ankle arthrodesis. Conclusion: There is variation in the proportion of ankle replacements being performed compared to ankle arthrodesis for end stage ankle arthritis in each ICB and region. Patients are traveling further to receive an ankle replacement compared to an ankle arthrodesis. Further investigation is required into the potential causes of this variation and the availability of total ankle replacements to all patients across the UK. Patients should have access to all treatment options even if both operations are not performed by the consulting surgeon.
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BibTeX
@article{martin2026ankle,
title = {{Ankle arthrodesis and total ankle replacement – Variations in surgical practice across England using Hospital Episode Statistics database}},
author = {Rebecca Martin and Toby Jennison and William Keith Gray and Sarah Johnson-Lynn and Tim Briggs and David Townshend},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0359847},
url = {https://doi.org/10.1371/journal.pone.0359847},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Ankle arthrodesis and total ankle replacement – Variations in surgical practice across England using Hospital Episode Statistics database
AU - Rebecca Martin
AU - Toby Jennison
AU - William Keith Gray
AU - Sarah Johnson-Lynn
AU - Tim Briggs
AU - David Townshend
PY - 2026
DA - 2026/10/15
JO - PLOS One
DO - 10.1371/journal.pone.0359847
UR - https://doi.org/10.1371/journal.pone.0359847
AB - Background and Purpose: End stage ankle arthritis can be managed surgically by ankle arthrodesis or total ankle replacement. Not all surgeons perform both ankle arthrodesis and total ankle replacement. This study aims to determine the numbers of ankle arthrodesis and ankle replacements being performed throughout England and to analyse variation in provision. Methods: This is a retrospective study using Hospital Episode Statistics data from NHS England for the period April 2013 to March 2025 categorised geographically by Integrated Care Boards (ICB) and NHS England regions and over time by financial year. Results: A total of 26,331 procedures were performed for end stage ankle arthritis. There was variation between ICBs with regards to the proportion of ankle replacements and ankle arthrodesis being performed. Over the study period, most practices changed towards an increasing proportion of ankle replacements. Patients receiving ankle replacements travelled further for their operation compared to those receiving ankle arthrodesis. Conclusion: There is variation in the proportion of ankle replacements being performed compared to ankle arthrodesis for end stage ankle arthritis in each ICB and region. Patients are traveling further to receive an ankle replacement compared to an ankle arthrodesis. Further investigation is required into the potential causes of this variation and the availability of total ankle replacements to all patients across the UK. Patients should have access to all treatment options even if both operations are not performed by the consulting surgeon.
SN - 1932-6203
ER -