Early Indian experience with the VELYS robotic system: A consecutive series of first 1000 Total Knee Arthroplasty cases

Robotic total knee arthroplasty (rTKA) is increasing in popularity, with reported benefits including more accurate component positioning, reduced levels of pain, and greater patient satisfaction. Adoption of rTKA is increasing worldwide; however, adoption of this technology in developing countries is under-reported. The primary aim of this study is to provide an in-depth analysis of the first one-thousand cases performed by a single surgeon in a second-tier city in India using the VELYS Robotic-Assisted Solution. The secondary aim is to compare the results of simultaneous bilateral versus unilateral rTKA. This was a single centre series in which all included patients underwent rTKA for advanced symptomatic knee arthritis over a two-year period irrespective of the extent of the deformity, presence of metal work or pre-operative diagnosis. Data collected included patient demographics, degree of deformity, post-operative restoration of alignment, length of hospital admission, complications and Patient Reported Outcome Measures (PROMs) including Knee Society Score, Knee Society function score, and Oxford Knee Score. This study reports 1013 rTKA procedures, including 810 simultaneous bilateral and 203 unilateral procedures (22% male, mean age 65, SD 7.44). rTKA was successful in correcting the coronal plane deformity from a mean of 8.6 to 1.2 degrees in varus knees, and from 5.7 degrees to 1.1 degrees in valgus knees. Complications were seen in five cases including two post-operative deaths from viral pneumonitis (at six- and eight-months post-operative), one failure of the robot hardware requiring conversion to conventional TKA, and two bilateral patella fractures (both two weeks post-operatively). Degree of pre-operative deformity had no effect on length of hospital admission, post-operative range of movement, or PROMs. Performance of bilateral rTKA was associated with reduced tourniquet times and increased blood loss; these factors however, did not affect post-operative range of motion, PROMs, or complication rates. Transition to rTKA, both unilateral and simultaneous bilateral, produced safe and consistent outcomes with a short learning curve in a large Indian population.