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.
Highlights
Several factors, such as age, diabetes, smoking, or infections, affect osseous consolidation and patient outcome after orthopedic and trauma surgery [1,2,3,4]
Osseous Consolidation Was Independent of Sex, body mass index (BMI), or Wedge Height 33.4.4..OOsssseeoouussCCoonnssoolildidaattioionnWWaassIInnddeeppeennddeennttooffSSeexx,BBMMII,oorrWWeeddggeeHHeeigighhtt In order to identify factors, which might influence the ELF-PEMF therapy, subgroup analyses wHewHowHrwoeeoerwerwepveIeeInpeevnprvreefo,eeroorrrtfr,rhrdfo,tdomerethrehmsremereestdestoeefdoeadfficfoafdiafdotcreooctrentortrnohtstrthtirsehfidsefydeyiededifffediffadffaencfenccteonctootcttoorttortisoinsof,nif,nfflwsfswfluseeulheuxxheeix,encin,chnBBcchBceMeMmMemttIhtIhiI,ghi,eegaheaahnrrtnnraatdaiddttniteenwefwwoflooulefufeefdeoddeonogsngsgcsescseseeeeeehohtooheutheuuhieesgieissgghcEhccEothLootnLtonFnosFnos-son-PonolPtiElthldiEhitMdedhaMeataerFtirFatoiaiorttnottehanehnte(oee(Fro(FfraiFfoagipogipfougysuysrso,urse,esseerossu5eou5ueAbu5Aobsgs–Agu–rcCrcoCs–ooo)uCn).cun.pso)pso.noalailsndinodaaallatiyltdiyoisosaenents.is.on
The above-mentioned studies investigated patients with rather poor bone metabolism. These findings support our hypothesis that ELF-PEMF therapy mainly supports osseous consolidation in patients with risk factors for pseudarthrosis or delayed union, e.g., elderly or malnourished patients, smokers, diabetics, or patients frequently consuming alcohol or using non-steroidal anti-inflammatory drugs (NSAIDS) [3,40]
Summary
Several factors, such as age, diabetes, smoking, or infections, affect osseous consolidation and patient outcome after orthopedic and trauma surgery [1,2,3,4]. Despite the overall positive effects of EMFs on bone formation [15,16], small numbers of cases, inhomogeneous study cohorts, and lack of placebo controls and/or blinding limit the validity of the studies [17,18,19,20,21] Compared to existing in vivo studies, with treatment durations of several hours daily [20,21], this short treatment duration is thought to increase compliance [24] Based on these studies, it was proposed that this specific ELF-PEMF can improve bone formation in vivo. Subgroup analyses are performed to identify the possible influence of sex, BMI, age, and wedge height, with stronger treatment effects expected in elderly patients
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