Comparison of Radiographic Accuracy and Clinical Outcomes Between Velys-assisted total knee arthroplasty and conventional total knee arthroplasty: A Meta-Analysis

Background The goal of the image-free VELYS Robotic-Assisted total knee arthroplasty is to maximize soft tissue kinematics and surgical precision during total knee arthroplasty (TKA). However, clinical evidence regarding its superiority over manual techniques remains equivocal. This is the first meta-analysis to synthesize the perioperative, functional, and radiographic performance of VELYS-assisted TKA (VELYS-TKA) compared with conventional TKA (C-TKA). Methods A comprehensive literature search was performed in PubMed, Embase, and the Cochrane Library, as well as major Chinese databases including CNKI and Wanfang, to identify relevant comparative studies published up to January 2026. Our analysis focused primarily on patient-reported outcomes, including the KSS and VAS. Surgical factors and safety outcomes were also examined, covering range of motion, length of hospital stay, operative time, and the occurrence of complications, MUA, and revision surgery. Statistical computations were performed using STATA MP software (v18.0) Results Nine qualifying studies were incorporated, involving 138,441 patients undergoing primary total knee arthroplasty (TKA). The meta-analysis indicated no significant differences between VELYS-assisted TKA and conventional TKA regarding KSS knee score (P = 0.43), dynamic VAS score (P = 0.38), flexion-extension range of motion (P > 0.05), or operative time (P = 0.29). The revision rate, the rate of manual reduction under anesthesia (MUA), and the overall complication rate were all similar for the two surgical methods. In contrast, patients undergoing VELYS-assisted TKA experienced faster early functional recovery, as evidenced by higher KSS functional scores (P < 0.001), lower static VAS scores (P = 0.04), and shorter hospital stays (P < 0.001). Conclusion The VELYS robotic system is safe and feasible alternative to standard TKA without increasing operative time or risk with real benefits in promoting early functional recovery and shorter hospital stay. Although these early results are promising, long-term durability and cost-effectiveness of the platform should be validated in high-quality multicenter randomized trials with extended longitudinal follow-up.