Regional Trends and Variation in Knee Osteotomy Surgery in England, UK: A Longitudinal Analysis of National Health Service Data over Twenty Years

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.