# National Trends in Total Ankle Replacement in Sweden: Demographic Shifts and Regional Disparities (2008-2023)

## TL;DR

This study examines how total ankle replacement surgeries in Sweden have increased over 16 years, with more procedures in older and male patients and regional differences.

## Contribution

The study provides the first detailed national analysis of TAR trends in Sweden, highlighting demographic and geographic shifts.

## Key findings

- TAR procedures increased by 205% from 2008 to 2023.
- Older patients (≥65 years) and males became the primary recipients of TAR.
- Regional disparities in TAR incidence persist but have slightly narrowed.

## Abstract

Total ankle replacement (TAR) is a surgical option for end-stage ankle arthritis, offering pain relief while preserving joint mobility. Although TAR utilization has increased globally, limited data exist regarding demographic and regional trends in Sweden in the last decade. This study aims to analyze national trends in TAR between 2008 and 2023, with a focus on age, sex, and geographic disparities.

This retrospective cohort study used data from the Swedish National Patient Register (NPR) to identify all patients aged ≥15 years who underwent primary cementless TAR between January 1, 2008, and December 31, 2023. Exploratory analyses used descriptive statistics to examine trends in procedure volume, incidence, and demographic distribution. Regional incidence rates were calculated using population data.

A total of 1255 primary TAR procedures were identified during the study period. The volume of surgical cases increased by 205%, from 63 cases in 2008 to 129 cases in 2023. The incidence doubled from 0.6 to 1.2 per 100 000 inhabitants, despite a 14% increase in population size between 2008 and 2023. Female patients constituted 55% of overall cases, though male patients became the majority by 2023. Nearly half of all TARs were performed in individuals aged ≥65 years, with the 70-79-year age group showing the greatest relative increase (350%). Regional disparities were noted, with high variability in incidence between regions. Projections indicate that future incidence will rise for men and decrease for women.

The utilization of TAR in Sweden has increased substantially over the past 16 years, with notable demographic shifts toward older and male patients. Geographic disparities persist but have narrowed slightly. These findings highlight the importance of ongoing evaluation of access to TAR and the variability of surgical practices. Further studies are necessary to evaluate the continued development of TAR.

Level III, retrospective cohort study.

Graphical Abstract