# Decreasing utilization of tibial osteotomy and regional disparities: A population‐based study of all surgeries in Sweden from 2008 to 2023

## TL;DR

Tibial osteotomy surgeries in Sweden have decreased over time, with big differences between regions, and are expected to keep declining due to other surgical options becoming more popular.

## Contribution

This study provides population-based evidence on the declining use of tibial osteotomy in Sweden and highlights regional disparities.

## Key findings

- Tibial osteotomy incidence in Sweden dropped from 5.0 to 2.3 per 100,000 between 2008 and 2023.
- The procedure decline was more pronounced in men, reducing the sex-based incidence gap.
- Regional variations in TO utilization were significant, with some areas performing far above or below the national average.

## Abstract

Tibial osteotomy (TO) is a surgical procedure used to treat unicompartmental gonarthrosis and correct lower extremity deformities. While historically effective, TO utilization has declined, possibly due to advances in alternative procedures such as unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). The aim of this study is to describe and highlight demographic characteristics, trends in utilization and regional variance of TO in Sweden during 2008 to 2023 as well as estimate the usage by 2030.

A retrospective cohort study was conducted using the Swedish National Patient Register, including all TO procedures performed between 1 January 2008 and 31 December 2023. Incidence rates per 100,000 inhabitants were calculated. Statistical analyses included descriptive statistics, Student's t tests for group comparisons, and regression modelling for future incidence trends.

A total of 4729 TO procedures were performed, averaging 296 per year. The overall incidence declined from 5.0 per 100,000 in 2008 to 2.3 in 2023. The decline was greater among men than women, narrowing the sex‐based incidence gap. Most TOs were performed in patients aged 45–54 years (35%), followed by 55–64 years (24%). Large regional variations were observed, with regions both over‐ and underperforming the national average of TOs significantly. Predictive modelling suggests a continued decline, with an estimated incidence of 0.8 per 100,000 by 2030.

TO utilization in Sweden has declined and is estimated to continue decreasing in the future, likely due to increased UKA and TKA adoption. Regional disparities suggest variations in clinical practice and healthcare accessibility. Further research is needed to evaluate indications for TO as well as to establish the role of TO in current knee osteoarthritis management.

Level II.