Rheumatol Int (2009) 29:663–666
DOI 10.1007/s00296-008-0754-x
O R I G I N A L A R T I CL E
The eVects of pulsed electromagnetic Welds in the treatment
of knee osteoarthritis: a randomized, placebo-controlled trial
Saime Ay · Deniz Evcik
Received: 12 June 2008 / Accepted: 19 October 2008 / Published online: 18 November 2008
© Springer-Verlag 2008
Abstract In this study, we planned to investigate the
eVects of pulse electromagnetic Weld (PEMF) on pain relief
and functional capacity of patients with knee osteoarthritis
(OA). Fifty-Wve patients with knee OA were included in a
randomized, placebo-controlled study. At the end of the
therapy, there was statistically signiWcant improvement in
pain scores in both groups (P < 0.05). However, no signiW-
cant diVerence was observed within the groups (P > 0.05).
We observed statistically signiWcant improvement in some
of the subgroups of Lequesne index. These are morning
stiVness and activities of daily living activities compared to
placebo group. However, we could not observe statistically
signiWcant diVerences in total of the scale between two
groups (P > 0.05). Applying between-group analysis, we
were unable to demonstrate a beneWcial symptomatic eVect
of PEMF in the treatment of knee OA in all patients. Fur-
ther studies using diVerent types of magnetic devices, treat-
ment protocols and patient populations are warranted to
conWrm the general eYcacy of PEMF therapy in OA and
other conditions.
Keywords Osteoarthritis · Pulse electromagnetic Weld ·
Knee · Lequesne index
Introduction
Osteoarthritis (OA) is a chronic degenerative joint disease
with destruction of joint cartilage. Pain, stiVness and limita-
S. Ay (&) · D. Evcik
Department of Physical Medicine and Rehabilitation,
Ufuk University School of Medicine Doctor RÂdvan Ege Hospital,
Balgat, 06520 Ankara, Turkey
e-mail: saimeay@yahoo.com
tion in range of motion are main symptoms in knee OA. It is
often associated with impaired quality of life and disability.
The goals of treatment are to relieve pain, to provide move-
ment improvement and increase functional capacity. There
are various treatment modalities including oral/intraarticular
drugs, exercise, physical therapy and Wnally joint replace-
ment surgery [1, 2]. These treatment modalities were shown
to be eVective; however, they sometimes lead to adverse
eVects and were not found to be cost eVective. Therefore,
we need alternative treatment choices; one of which is elec-
tromagnetic Welds. Indeed electromagnetic Weld therapy has
been available for many years, but its widespread usage
over the world is limited [3]. Recently, new technological
devices were designed in accordance with human bio-
rhythm. It may be used in direct mode and mostly used in
pulse mode. Pulse electromagnetic Weld (PEMF) activates
biological processes including an increase in erythrocyte
membrane potential, tissue oxygenation, vascular vasodila-
tation and pain relief without heating [4, 5].
There is no consensus about the mechanism, indications,
treatment duration, application techniques and frequency of
PEMF due to the lack of randomized, placebo-controlled
double-blind studies [6]. In this study, we planned to inves-
tigate the eVects of PEMF on pain relief and functional
capacity of patients with knee OA.
Patients and methods
Fifty-Wve patients (40 females/15 males) suVering from knee
OA participated in the study. Diagnosis of OA was based on
the criteria of American College of Rheumatology [7].
Patients having eVusion in knees, previous knee arthroplasty,
severe hip and lumbar OA, neurologic diseases, malignancy
and pregnancy were excluded from the study. Also patients
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who had physical therapy program and intraarticular cortico-
steroid or hyaluronic acid injections within 6 months were
excluded. After physical examination, full blood count eryth-
rocyte sedimentation rate (ESR) and biochemical markers
were evaluated. All patients received weight-bearing antero-
posterior and lateral X-rays. These were evaluated according
to Kellgren and Lawrence criteria and the patients having OA
of Grades 2 and 3 were included in the study [8, 9].
Study design
This was a prospective, randomized, placebo-controlled
assessor-blind trial. Before treatment, all participants were
informed of the study and signed written informed consent.
Patients were randomly assigned to two groups and they
were allocated to the groups in order of their admittance to
the outpatient clinic. Before treatment, one physician evalu-
ated the clinical assessment parameters. Post-treatment out-
come measures were assessed by the same physician who
was not aware of the therapy. It was explained at the end of
the therapy sessions.
Group 1 (n = 30) received hot-pack and transcutaneous
electrical nerve stimulation (TENS) over knees for 20 min.
Additionally, this group received PEMF therapy for
30 min. PEMF was applied at a frequency of 50 Hz with an
intensity of 105
T (MRS 2000 + Home Device).
Group 2 (n = 25) was accepted as placebo group. They
received hot-pack, TENS and placebo PEMF therapy. Dur-
ing therapy, PEMF was applied on the same area for the
same period without turning on the device.
Also, both groups had isometric quadriceps exercise pro-
gram under the supervision of a physiotherapist. All
patients participated in the therapy programs for 3 weeks
(15 sessions). During the therapy program, they were not
allowed to take any of the analgesic drugs.
Clinical outcomes
Before measuring the clinical outcomes, patients were
asked about the morning stiVness. They underwent a physi-
cal examination by means of the limitation in range of
motion (ROM) and having crepitation.
Pain
Pain was assessed by using a 10-cm visual analogue scale
(VAS), with 0 as no pain and 10 as worst pain and Likert
pain scale (0 is the best and 4 is the worst) [10].
Functional capacity
Functional capacity was assessed by Lequesne Algofunc-
tional index of knee. It consisted of three subgroups with
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Rheumatol Int (2009) 29:663–666
ten items. These were pain or discomfort (Wve items), max-
imum distance walked (one item) and activities of daily liv-
ing (four items). Each item was scored between 0 and 2,
and total score ranged between 0 and 24. Higher scores
indicate higher functional limitation [11].
Statistical analysis
The means and standard deviations were given as descrip-
tive statistics. For determining the diVerence before and
after treatment for all groups, Wilcoxon test was used. To
compare the diVerence between groups, Mann–Whitney U
test was used. All analyses were performed by using the
SPSS for Windows 10.0 software program.
Results
All the patients completed the study period and no one had
adverse eVect. Demographic data from the treatment and
control group were listed in Table 1. No statistically signiW-
cant diVerences were observed in baseline measurements
between the groups. The results of full blood count ESR and
biochemical markers were in normal ranges for both groups.
Thirty patients (54%) described morning stiVness of less
than 30 min and 50 (91%) patients had crepitation in physi-
cal evaluation. No one had used adaptive devices such as
crutches. Most of the patients had Grade 3 OA based on
radiologic criteria (Table 2).
Pain
At the end of the therapy, there was statistically signiWcant
improvement in VAS and Likert scores in both Group 1 and
Group 2 (P = 0.000 and 0.000, respectively). However, no
signiWcant diVerence was observed within the groups
(P = 0.343 and 0.400, respectively). The results are shown
in Table 3.
Functional capacity
We observed statistically signiWcant improvement in some
of the subgroups of Lequesne index. These are morning
Table 1 Baseline demographic characteristics in two groups of pa-
tients with knee OA randomized to receive PEMF and placebo in a
therapeutic study
Group 1 (n = 30) Group 2 (n = 25)
Age 58.9 § 8.8 57.7 § 6.5
Sex (% female) 70 76
Disease duration (month) 43.3 § 55.2 42.5 § 49.0
Living sedentary life (%) 52 50
Rheumatol Int (2009) 29:663–666 665

Table 2 Distribution of the groups according to Kellgren Lawrence for the treatment of avascular necrosis, soft tissue prob-
radiological grade lems, osteoporosis and painful musculoskeletal disorders, it
Group 1 (n, %) Group 2 (n, %) has received approval by Food and Drug Administration
only for treatment of delayed bone fractures [15–19]. Clini-
Grade 0 0 (0%) 0 (0%) cal studies show its beneWcial eVects on knee OA, but
Grade 1 3 (10%) 5 (20%) because of the lack of scientiWc studies, American College
Grade 2 13 (43.3%) 8 (32%) of Rheumatology does not recommend it in the treatment of
Grade 3 14 (46.7%) 12 (48%) OA. Nevertheless, it has a big popularity in recent years;
Grade 4 0 (0%) 0 (0%) also, it is an inexpensive therapy [4, 20].
In this study, we investigated the eVects of PEMF on
pain relief. We observed a statistically signiWcant improve-
Table 3 Pain and Lequesne severity index values of the groups before
and after the treatment
ment in VAS and Likert scores after the therapy sessions.
However, no diVerence was obtained between groups.
Group 1 Group 2 P Contrarily, some of the researchers reported an improve-
VAS (BT) 4.24 § 1.83 4.23 § 1.71 0.89 ment in pain and functional capacity after PEMF treatment
VAS (AT) 2.58 § 1.37 2.24 § 1.14 0.34 in knee OA. These eVects may be due to activation of chon-
P 0.000 0.000
drocyte receptors and transforming growth factor
, which
Likert (BT) 2.81 § 1.59 2.71 § 1.59 0.75
play an important role in cartilage repair [20]. Also, Trock
Likert (AT) 1.34 § 0.72 1.28 § 1.07 0.40
et al. showed that PEMF has beneWcial eVects in pain on
both knee and cervical OA. This was probably because of
P 0.000 0.001
the stimulatory eVects of osteoblasts and an increase in syn-
Lequesne index (BT) 10.96 § 4.85 10 § 4.13 0.59
thesis of glycosaminoglycans [21].
Lequesne index (AT) 7.76 § 4.68 7.1 § 4.10 0.35
Sütbeyaz et al. applied the eVect of PEMF in patients
P 0.000 0.000
with cervical OA; signiWcant improvements were observed
VAS visual analog scale, BT before treatment, AT after treatment in pain, range of motion and functional status. PEMF might
enhance the repair of cartilage and cause the calcium and
stiVness (P = 0.059) and activities of daily living activities other ion movements across the cell membranes [22].
(descending stairs, P = 0.002; walking on rough surface, Additionally, Pipitone and Scott used WOMAC pain
P = 0.003) compared to placebo group. However, we could score and VAS for pain assessment and WOMAC func-
not observe a statistically signiWcant diVerences in total of tional score and Lequesne index for disability assessment.
the scale between two groups (P = 0.351). They found a signiWcant improvement in WOMAC pain
and functional index scores, whereas no diVerence was
obtained in VAS and Lequesne scores compared to placebo
Discussion group [4]. This controversial result may be due to the less
sensitivity of Lequesne index and VAS may be eVected
It is well known that, above the age of 65 years, OA is the from multiple factors even emotional mood. We could not
most common rheumatologic disorder, which is character- Wnd any signiWcant diVerence between the groups, and if
ized by joint pain, stiVness and functional limitation. It is we used WOMAC pain index, probably our results may be
estimated that, above the age of 40 years, approximately diVerent from that one.
90% of the population has radiological signs of OA without The mechanism of PEMF in pain management depends
symptoms [12–14]. on the suppression of inXammation, metabolic activation of
The treatment should be focused on pain relief. Pharma- mesenchymal cells and the modiWcation of pain perception
cological and nonpharmacological methods including phys- locally [4]. Therefore, it may not be eVective in central pain
ical therapy modalities and exercise programs are used for mechanism and be easily inXuenced by emotional factors.
pain management [2]. Nonsteroidal anti-inXammatory Thamsborg et al. investigated the eVectiveness of PEMF
drugs and analgesic drugs such as paracetamol are com- in knee OA in a randomized, double-blind, placebo-con-
monly preferred. Such medications usually have gastroin- trolled study. They only found beneWcial eVect in stiVness
testinal adverse eVects, which seem to be important in older above the age of 65 years compared to placebo. This eVect
age population. Thus, we need some other alternative thera- is because of the enhanced periarticular blood circulation,
pies [13, 14]. Physical therapy applications (heat-cold, positive eVects on cartilage diVerentiation and activation of
TENS, ultrasound, photophoresis, exercise) are found to be the synthesis of nitric oxide [23].
eVective in OA. PEMF is used for centuries, but nowadays In conclusion, there is no standard treatment procedure
it has become popular again [3]. Although it has been used for certain musculoskeletal diseases. The beneWcial eVect

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of PEMF on pain relief makes it a potential alternative
treatment modality for OA. Further studies should be
needed for standardization of dosage and treatment dura-
tion in various disorders.
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