Revision Total Ankle Arthroplasty Using the INVISION Modular Implant System: A Systematic Review and Meta-Analysis.

BACKGROUND

Globally, rising rates of ankle arthritis have largely driven increases in total ankle arthroplasty (TAA) and revision TAA (rTAA). INVISION (Wright Medical/Stryker) is a novel modular implant system designed for addressing rTAA-associated challenges; however, clinical outcomes remain limited. Therefore, the purpose of this systematic review is to synthesize the available INVISION rTAA literature to evaluate implant survivorship and complication rates.

METHODS

A PROSPERO-preregistered query of PubMed/MEDLINE, Embase, Cochrane, CINAHL, and Web of Science was performed on August 18, 2025, to identify INVISION-using rTAA studies. Quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS). Extractions included demographics and operative outcomes. Statistics included frequency-weighted means (FWMs) and meta-analyses.

RESULTS

Five retrospective studies were included (mean MINORS = 10.2 ± 0.8; n = 100; FWM age = 64.0 ± 8.4 years; follow-up = 2.8 ± 1.2 years; 56% male; body mass index = 30.5 ± 5.5 kg/m2; time-to-revision = 4.5 ± 2.5 years). Tibial-talar implant permutations were INVISION-INVISION (25%), INVISION-INBONEII (19%), and INBONEII-INVISION (56%). Patients underwent an average of 1.8 additional procedures to rTAA: frequently medial malleolus fixation (21.8%) and hardware removal (17.3%). Pooled implant survivorship was 88%. Complication rates varied (0%-39.3%), and the all-cause rTAA pooled reoperation rate was 21%, driven primarily by aseptic loosening (38.1%) and infection (28.6%). The pooled re-revision rate was 11%. Meta-analyses revealed no significant differences in either all-cause reoperation or re-revision risk when comparing INVISION-INVISION to any other implant permutations.

CONCLUSION

INVISION rTAA demonstrated early survivorship and complication rates that should be interpreted cautiously given retrospective study designs, high heterogeneity, "very low" GRADE outcome certainty, and limited follow-up duration. Aseptic loosening and infection remain the predominant drivers of reoperation and re-revision. No significant differences in these risks were detected across implant permutations. Future longitudinal, comparative studies are needed.