Keywords: Total Ankle Arthroplasty Prostheses, Total Ankle Arthroplasty, Revision Total Ankle Arthroplasty
Introduction/Purpose: Ankle arthritis affects approximately 1% of the population and is expected to continue increasing in prevalence. Surgical options include arthrodesis and total ankle arthroplasty (TAA), the latter of which has seen increasing utilization over recent decades, accompanied by a parallel rise in revision TAAs (rTAAs). Consequently, there has also been an emergence of many innovative rTAA-targeted implant designs to better address the challenges of revision surgery. The INVISION system (Wright Medical/Stryker, Kalamazoo, MI) is one such design, notable for its modular, unique compatibility with other implants, however, there remains a paucity of patient outcome data. Given this, the present systematic review aims to collate the available literature on INVISION rTAA clinical outcomes to better guide implant-based decision- making and improve foot and ankle care.
Methods: Pre-registered on PROSPERO, this review queried PubMed/Medline, Embase, Cochrane, CINAHL, and Web of Science on August 18, 2025, for studies reporting rTAA outcomes that utilized the INVISION system. Article quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) scale. Extracted variables included demographics, operative details, patient-reported outcome measures (PROMs), reoperations, and re-revisions. Cohort statistics were calculated in Microsoft Excel using frequency weighted means (FWMs), pooled standard deviations, and pooled percentages, while meta-analyses (MA) with risk ratios (RRs) were calculated using the Statistical Package for the Social Sciences (SPSS).
Results: Five retrospective studies (mean MINORS=10.2±0.84, n=100, 56.0% male, age=64.0±8.4 years, follow-up=2.8±1.1 years, BMI=30.5±5.5 kg/m2) were included. Revision tibial-talar implant permutations were Invision-Invision (25%), Invision-InboneII (19%), and InboneII-Invision (56%), most often for tibial/talar subsidence (27.8%), aseptic loosening (26.4%), or infection (20.8%). FWM time-to-revision was 4.5±2.4 years, with 1.0 additional procedures on average. The all-cause reoperation rate was 21%, primarily due to infection (38.1%) and aseptic loosening (23.8%). No significant difference in reoperation risk was observed between Invision-Invision and any Invision/InboneII groups (RR=1.09, p=0.83). The re-revision rate was 11%, again led by infection (45.5%) and aseptic loosening (36.4%), with no difference between Invision-Invision and any Invision/InboneII groups (RR=0.63, p=0.46).
Conclusion: INVISION appears to be an efficacious modular system for patients undergoing rTAA, with positive patient outcomes and relatively low reoperation and re-revision rates regardless of system-specific implant permutation. As the first and largest review to evaluate INVISION, future high-quality studies with more robust outcome reporting strategies are warranted to gain additional insights regarding risk factors and additional associations within the complex and expanding rTAA population.
