Implant Survivorship and Radiographic Outcomes of Revision Total Ankle Arthroplasty Using a Modular Revision System.

Background: With the growing popularity of total ankle arthroplasty (TAA), there is an expectation that revision surgeries will increase. However, limited data exist on revision TAA outcomes using a revision-specific implant. The INVISION Total Ankle Revision System is a modular revision implant (Wright Medical Group/Stryker). The purpose of this study was to report implant survivorship, complications, and radiographic and clinical outcomes of revision TAA using the INVISION system at a minimum 2-year follow-up.

Methods: A retrospective review was conducted of 27 patients that underwent a revision TAA using the INVISION implant at a single institution with minimum 2-year follow-up between 2016 and 2020. Implant survivorship was the primary outcome. Demographics, complications, reoperation, and radiographic and clinical outcomes were recorded.

Results: Implant survivorship was 81.5% (22/27) at a mean of 3.6 years following revision TAA using the INVISION implant. There was evidence of aseptic loosening in 3 patients and talar subsidence in 4 patients on final radiographs. Reoperation rate at final follow-up was 40.7%, most commonly for aseptic loosening (n = 3), septic TAA (n = 2), or gutter impingement (n = 2). The mean American Orthopaedic Foot & Ankle Society (AOFAS) total score was 54.5, Foot and Ankle Ability Measure (FAAM) activities of daily living (ADL) subscale score was 52.9, and FAAM Sports was 31.0.

Conclusion: Revision TAA using the INVISION implant demonstrated 81.5% implant retention at a mean of 3.6 years in this complex cohort. Patient-reported outcomes were lower than those reported after primary TAA. Physicians and patients should recognize that revision TAA remains a challenging procedure with a high rate of complications and reoperations.