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/m 2 ; 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.