Robotic versus conventional knee replacement with a virtual home-based rehabilitation program.

Robotic-assisted total knee arthroplasty (RTKA) Participants will undergo robotic-assisted total knee arthroplasty performed by an experienced orthopaedic surgeon using the VELYS™ Robotic-Assisted Solution (DePuy Synthes / Johnson & Johnson MedTech). - Duration of surgery: Typically up to approximately 120 minutes, depending on clinical complexity. - Use of robotic assistance: The system is used for pre-operative planning and intra-operative guidance of bone resections and implant positioning in accordance with manufacturer guidelines and standard surgical practice. - Monitoring of intervention fidelity: Surgical details, including procedure type (robotic-assisted), tourniquet time, and intra-operative variables, will be documented in standardised operative reports by the treating surgeon. No additional adherence monitoring is required for the surgical intervention. Pre-operative virtual comprehensive care program (4 weeks) Exercise program: Participants complete a structured home-based exercise program delivered via a digital application. - Frequency and duration: - 2–3 sessions per day, - Each session approximately 5–15 minutes, - 7 days per week. - Exercise components include: - Cycling-based interval exercise using an upright stationary cycle (varying resistance and intensity) - Knee range-of-motion exercises (e.g., knee flexion stretch) - Strengthening exercises (e.g., straight leg raise, resisted knee extension, resisted hip extension, heel raises) - Functional exercises (e.g., mini squats, sit-to-stand, isometric wall sit) Exercises are progressed using symptom-based criteria (pain and perceived exertion). Education component: Participants receive structured education during the pre-operative phase, including: - Understanding the surgical procedure and expected recovery - Pain management strategies - Safe exercise participation and progression - Use of the stationary cycle and digital platform - Expectations for post-operative rehabilitation and activity Delivery format: - Physiotherapist-led in-person onboarding session - Supplemented by digital app-based guidance, written materials, and in-app prompts Telehealth and support: - Initial in-person onboarding session (equipment setup and education) - Ongoing remote monitoring and tele-messaging support during business hours (weekdays) - Telehealth consultations are provided as required, based on participant symptoms, adherence, or clinician judgement Adherence monitoring Adherence is monitored using a digital rehabilitation platform, including: - Automatic capture of cycling data (frequency, duration, cadence, power output) - App-based logging of exercise completion - Participant-reported pain and perceived exertion after sessions - Physiotherapist review of adherence and progression via a cloud-based system Post-operative rehabilitation program (6 weeks) Exercise program The post-operative program continues the same structured approach as the pre-operative phase, with progression based on recovery status. - Frequency and duration: - 3 sessions per day, - Each session approximately 8–16 minutes, - 7 days per week - Exercise components include: - Cycling-based rehabilitation (initially partial revolutions/rocking ? progressing to full cycling) - Knee range-of-motion exercises - Strengthening exercises - Functional and mobility exercises (e.g., sit-to-stand, gait-related tasks) The exercise program is largely consistent with the pre-operative program, with early emphasis on: - regaining knee range of motion - gradual return to functional tasks Education component: The post-operative education component follows the same delivery model as the pre-operative phase (physiotherapist-led guidance supplemented by app-based materials and in-app prompts), with content adapted to the recovery phase. Education topics are similar to those provided pre-operatively, with greater emphasis on: - Pain and swelling management during recovery - Safe progression of exercises following surgery - Use of the stationary cycle in rehabilitation - Return to daily activities and functional tasks - Recognition of adverse symptoms and when to seek clinical review Education is reinforced through telehealth interactions and tele-messaging and is individualised according to participant recovery status. Telehealth and support: - Ongoing remote monitoring and tele-messaging support (weekdays) - Telehealth consultations provided as clinically indicated based on symptoms and recovery - Physiotherapist oversight throughout the rehabilitation period Adherence monitoring: Same as pre-operative phase: - Digital platform monitoring of cycling and exercise completion - Pain and exertion tracking - Physiotherapist review of adherence and progression decisions - All deviations and modifications recorded within the system