Pulsed Electromagnetic Field Therapy Improves Osseous Consolidation after High Tibial Osteotomy in Elderly Patients—A Randomized, Placebo-Controlled, Double-Blind Trial

Abstract

Extremely low-frequency pulsed electromagnetic field (ELF-PEMF) therapy is proposed to support bone healing after injuries and surgical procedures, being of special interest for elderly patients. This study aimed at investigating the effect of a specific ELF-PEMF, recently identified to support osteoblast function in vitro, on bone healing after high tibial osteotomy (HTO). Patients who underwent HTO were randomized to ELF-PEMF or placebo treatment, both applied by optically identical external devices 7 min per day for 30 days following surgery. Osseous consolidation was evaluated by post-surgical X-rays (7 and 14 weeks). Serum markers were quantified by ELISA. Data were compared by a two-sided t-test (α = 0.05). Device readouts showed excellent therapy compliance. Baseline parameters, including age, sex, body mass index, wedge height and blood cell count, were comparable between both groups. X-rays revealed faster osseous consolidation for ELF-PEMF compared to placebo treatment, which was significant in patients ≥50 years (∆mean = 0.68%/week; p = 0.003). Findings are supported by post-surgically increased bone-specific alkaline phosphatase serum levels following ELF-PEMF, compared to placebo (∆mean = 2.2 µg/L; p = 0.029) treatment. Adverse device effects were not reported. ELF-PEMF treatment showed a tendency to accelerate osseous consolidation after HTO. This effect was stronger and more significant for patients ≥50 years. This ELF-PEMF treatment might represent a promising adjunct to conventional therapy supporting osseous consolidation in elderly patients. Level of Evidence: I.

Exposure to 16 Hz Pulsed Electromagnetic Fields Protect the Structural Integrity of Primary Cilia and Associated TGF-β Signaling in Osteoprogenitor Cells Harmed by Cigarette Smoke

“…The effectiveness of the ELF-PEMF was confirmed in further studies, both in vitro and in vivo [25,29]. Comparing the effect on bone formation in this in vivo study [29] with other studies that used 4-to 200-times longer daily exposures revealed that increasing the exposure duration may enhance the observed effects [9]. Thus, in the present study, exposure duration was varied at first.…”

“…A screening approach identified ELF-PEMFs in this frequency range to best support the viability and differentiation of osteoprogenitor cells [12]. The effectiveness of the ELF-PEMF was confirmed in further studies, both in vitro and in vivo [25,29]. Comparing the effect on bone formation in this in vivo study [29] with other studies that used 4-to 200-times longer daily exposures revealed that increasing the exposure duration may enhance the observed effects [9].…”

Modulation of Macrophage Activity by Pulsed Electromagnetic Fields in the Context of Fracture Healing

“…For example, the 16 Hz ELF-PEMF induced osteoblast function in patients undergoing high tibia osteotomies. However, no effect on osteoclast inflammatory markers was observed [ 36 ]. By changing the frequency “window”, other cells might be addressed.…”

Translational Insights into Extremely Low Frequency Pulsed Electromagnetic Fields (ELF-PEMFs) for Bone Regeneration after Trauma and Orthopedic Surgery

“…The fourth study used an ELF-PEMF with a frequency of 15 Hz for 4 h per day for more than 1 year during limb lengthening [118]. The fifth study used an ELF-PEMF with a frequency of 16 Hz for only 7 min per day for 30 days following high tibial osteotomy [120]. In three studies, commercial ELF-PEMF devices were used, namely EBI stimulator (Electro-Biology Inc, Fairfield, NJ, USA) [118], BIOSTIM®(IGEA S.p.A., Carpi, Italy) [119], and Somagen®(Sachtleben GmbH, Hamburg, Germany) [120].…”