Incidence Rates of Total Ankle Replacements and Ankle Fusions in the Scandinavian Countries Between 2016 and 2023

BACKGROUND: Total ankle replacement (TAR) has developed rapidly during the last decades, and there is solid evidence that this is a good treatment for end-stage ankle arthritis (ESAA). Whether these improved outcomes have translated into a higher utilization of TARs compared with ankle fusions (AFs) in Scandinavia is unknown. The aim of this study was to report the incidences of TAR and AF in the Scandinavian countries and to report any trends in these incidences during the last 8 years. METHODS: Data were collected from the official patient registries of the three countries for the period 2016-2023, using NOMESCO codes for TAR and AF. To evaluate the capacity for highly specialized foot and ankle surgery, data about triple fusions and calcaneal osteotomies were also collected. Trends in incidence rates were evaluated with negative binomial regression. RESULTS: During the period, 5667 AFs and 2012 TARs were performed in the three countries, which gives an ankle replacement percentage (ARP) of 26% for the whole region. Denmark had a higher total procedure volume, a higher number of TAR, and a higher ARP than the other countries (38% vs 20% for the two other countries, P ≤ .001). There was an increasing incidence of TAR during the period in Denmark and Sweden, while there was a decrease in Norway. CONCLUSION: The incidence of TAR and the ARP vary between the Scandinavian countries, where Denmark has a much higher incidence of TARs than the other two countries. In the last 8 years, the incidence of TARs has been stable in Denmark, increasing in Sweden and decreasing in Norway.