Ankle arthrodesis and total ankle replacement – Variations in surgical practice across England using Hospital Episode Statistics database

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.