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PEMF Improves Osseous Consolidation

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Journal of
Clinical Medicine
Pulsed Electromagnetic Field Therapy Improves Osseous Consolidation after High Tibial Osteotomy in Elderly Patients—A Randomized, Placebo-Controlled, Double-Blind Trial
Patrick Ziegler 1,†, Andreas K. Nussler 1,*,† , Benjamin Wilbrand 1, Karsten Falldorf 2, Fabian Springer 3, Anne-Kristin Fentz 2, Georg Eschenburg 2 , Andreas Ziegler 4,5 , Ulrich Stöckle 6, Elke Maurer 1, Atesch Ateschrang 1, Steffen Schröter 1 and Sabrina Ehnert 1
2 3
4 5
† These authors contribute equally to this work.
Received: 30 October 2019; Accepted: 15 November 2019; Published: 17 November 2019
Siegfried Weller Institute for Trauma Research, Department of Trauma and Reconstructive Surgery,
BG Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, Schnarrenbergstr. 95, D-72076 Tübingen, Germany; (P.Z.); (B.W.); (E.M.); (A.A.); (S.S.); (S.E.)
Sachtleben GmbH, Haus Spectrum am UKE, Martinistraße 64, D-20251 Hamburg, Germany; (K.F.); (A.-K.F.); (G.E.)
Department of Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Str. 3, D-72076 Tübingen, Germany;
StatSol Lübeck, Moenring 2, D-23560 Lübeck, Germany;
School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, Scottsville 3209, South Africa
Center for Musculoskeletal Surgery, Charité—University Medicine Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany;
* Correspondence:; Tel.: +49-7071-606-1065
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.
Keywords: extremely low frequency pulsed electromagnetic field (ELF-PEMF) therapy; high tibial osteotomy (HTO); osseous consolidation; bone specific alkaline phosphatase (BAP); elderly

J. Clin. Med. 2019, 8, 2008; doi:10.3390/jcm8112008

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