Highlights:
- Successful healing in a high-risk, complex case: In a 75-year-old woman with a difficult periprosthetic tibial fracture and failed conservative treatment, adding PEMF stimulation led to full clinical and radiographic consolidation without the need for further surgery.
- Steady functional progress over time: After just 4 weeks of PEMF therapy, the patient improved enough to move from a long leg cast to a hinged knee brace, progressed to 50% partial weight-bearing, and reached full weight-bearing by 4 months post-fracture.
- Durable long-term outcome: By 8 months, the fracture was fully consolidated, and at 21 months after the trauma the patient remained asymptomatic and fully weight-bearing, indicating a stable, lasting result.
- Promising option when surgery is high-risk: As the first reported successful use of PEMF in a periprosthetic tibial fracture, this case suggests that pulsed electromagnetic field stimulation may be a valuable non-invasive adjunct in complex fractures, especially in frail patients where additional surgery carries greater risk.
Periprosthetic tibial fractures following total knee arthroplasty are rare but challenging complications, especially in patients who have undergone revision surgeries. The study conducted by Doorgakant, Bhutta, and Marynissen (2009) aimed to present the application and outcomes of using a pulsed electromagnetic field stimulation device (PEMFD) in managing a type IIA periprosthetic tibial fracture, representing the first documented case of therapeutic success with this intervention.
Intervention Used in the Study
The case involved a 75-year-old female patient with a history of advanced knee osteoarthritis and valgus deformity, who initially underwent a total knee arthroplasty. However, she developed medial collateral ligament failure, necessitating a revision surgery with a stemmed prosthesis.
Subsequently, the patient sustained a periprosthetic tibial fracture involving the metaphysis and fibula, with a gap exceeding 10 mm. Attempts at conservative treatment, such as manipulation under anesthesia and immobilization with a cast, proved ineffective.
Given this complex scenario, the use of a pulsed electromagnetic field stimulation device (Physio-stim, Intavent ORTHOFIX Ltd., UK) was chosen. The patient was instructed to use the PEMFD for at least 3 hours daily, continuing the protocol until bone consolidation was achieved.
Results Presented by the Study
The application of PEMFD yielded positive and progressive clinical outcomes:
- After 4 weeks of therapy, sufficient clinical stability was observed, allowing the long leg cast to be replaced with a hinged knee brace.
- The patient progressed to 50% partial weight-bearing and subsequently to full weight-bearing 4 months after the fracture.
- Complete bone consolidation, both clinically and radiographically, occurred 8 months after the fracture and 7 months after the initiation of PEMFD.
- At 21 months post-trauma and 14 months after bone consolidation, the patient remained asymptomatic and fully weight-bearing.
Figure 1. Functional Recovery Over Time After PEMF-Supported Treatment of a Periprosthetic Tibial Fracture. The step graph shows the patient’s functional status from the time of fracture through 21 months of follow-up. At baseline (0 months), she was immobilized in a long leg cast and non–weight-bearing. After 1 month of daily PEMF use, clinical stability improved and she transitioned to a hinged knee brace with limited weight-bearing. By 4 months, she had progressed to full weight-bearing. At 8 months, clinical and radiographic consolidation of the fracture was confirmed, and this fully weight-bearing, asymptomatic status was maintained at the 21-month follow-up.
Authors’ Interpretation
The authors interpreted this case as promising initial evidence of the efficacy of PEMFD in the treatment of periprosthetic tibial fractures, emphasizing that this is the first successful report in this specific context.
Despite the inherent limitations of a single case study, the results suggest that pulsed electromagnetic field stimulation may broaden its therapeutic indications, particularly in complex cases or in frail patients for whom additional surgical interventions could pose elevated risks.
Although bone consolidation took one month longer than the timeframe estimated by the device manufacturer, the authors considered the outcome favorable, taking into account the complexity of the fracture pattern and the patient’s clinical condition.
Reference: Doorgakant A, Bhutta MA, Marynissen H. Management of a tibial periprosthetic fracture following revision knee arthroplasty using a pulsed electromagnetic field stimulation device: a case report. Cases J. 2009;2:8706. Published 2009 Aug 5. doi:10.4076/1757-1626-2-8706