Pulsed Electromagnetic Fields Treatment May Counteract Periprosthetic Osteolysis

by | Dec 16, 2019 | 2018, Alternative Therapies, Bone Health

Written by Angeline A. De Leon, Staff Writer. A combination of pulsed electromagnetic fields and platelet rich plasma effectively treats an in vitro modal of periprosthetic osteolysis.

bone healthPeriprosthetic osteolysis refers to the active resorption of bone surrounding an implant, leading to bone loss, deterioration of the implant, and the need for surgical revision of the prosthetic 1. As debris particles accumulate on the surface of a prosthesis, an inflammatory response is triggered, resulting in osteoclastogenesis and further bone resorption 2. Currently, therapeutic treatment for periprosthetic osteolysis typically requires surgical revision, however, a promising strategy for counteracting osteolysis may involve treatment with pulsed electromagnetic fields (PEMFs), which have been used for osteoarthritis and bone fracture regeneration 3. PEMFs have been shown to facilitate healing around bone implants 4 and are associated with reduced pro-inflammatory activity 5. When combined with other treatments, platelet rich plasma (PRP), containing a concentration of growth factors and cytokines, has also demonstrated efficacy in healing bone defects and appears to exert a similar anti-inflammatory effect 6. In a recent in vivo study, the combination of PEMF with PRP was seen to produce greater cell viability, reduced osteoclastogenesis, and lower levels of inflammatory cytokines 7. In a follow-up investigation 8, Veronsi and colleagues examined the efficacy of PEMF and PRP, individually as well as in combination, in an in vivo model of periprosthetic osteolysis.

A total of 80 Fisher male rats were subjected to implantation with a titanium alloy pin in the distal femur and then injected with polyethylene particles at Week 6, 8, and 10 to induce osteolysis. Rats were randomized to four treatment groups: an untreated control group; a PRP group receiving PRP intra-articular injections every 2 weeks (3 injections of PRP at 15 µl each into the knee); a PEMF group receiving low-intensity and low-frequency PEMF stimulation for 6 hours daily for 60 days (at 75 Hz with a pulse duration of 1.3 ms); or a PRP + PEMF group receiving both treatment protocols. Rats underwent a high-resolution microtomography (micro-CT) scan to evaluate morphological changes around the implantation area, and additional histological and histomorphometric evaluations were carried out. Parameters of interest included bone volume (BV), bone-to-implant contact (BIC), and the number of osteoclasts (OC, involved in bone resorption) around the head of implant. Bone microhardness and bone maturation index (BMI%) were also calculated.

Histological and histomorphometric results indicated that relative to controls, PEMF (p < 0.0005), PRP (p < 0.05), and PEMF + PRP (p < 0.0005) resulted in significantly higher BV and BIC values. Compared to controls, OC number was also significantly lower in PEMF (p < 0.005), PRP (p < 0.05), and PEMF + PRP (p < 0.005). All treatment groups showed reduced formation of fibrous capsules at the implant-tissue interface (p < 0.005 for all), relative to controls, and was lower for the PEMF (p < 0.005) and PEMF + PRP (p < 0.0005) groups, compared to PRP. Finally, microhardness of bone at the implant interface was shown to be significantly lower in controls, relative to treatment groups (p < 0.0005) and lower in the PRP group than in the PEMF and PEMF + PRP groups (p < 0.0005). BMI% was also statistically higher in the PEMF + PRP group vs. controls (p < 0.05).

Data suggest that the use of PEMF treatment, by itself and in conjunction with PRP, may safely counteract the osteolysis process by increasing bone volume and reducing the number of cells involved in bone resorption. PEMF also effectively reduced fibrous tissue formation and was linked to relatively higher levels of bone mineralization. Thus, as a non-invasive, non-surgical form of therapy, PEMF offers a promising approach to treating osteolysis. A potential limitation of the study relates to the lack of measurement of inflammatory markers, which could be helpful in confirming whether treatments effectively lowered inflammation levels. Additional studies are needed to replicate findings in humans and to examine the efficacy of PEMF and PRP using variable schedules of treatment delivery.

Source: Veronesi F, Fini M, Sartori M, et al. Pulsed electromagnetic fields and platelet rich plasma alone and combined for the treatment of wear-mediated periprosthetic osteolysis: an in vivo study. Acta Biomaterialia. 20118; 77: 106-115. DOI: 10.1016/j.actbio.2018.07.012.

1742-7061/ 2018 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved

Posted December 16, 2019.

Angeline A. De Leon, MA, graduated from the University of Illinois at Urbana-Champaign in 2010, completing a bachelor’s degree in psychology, with a concentration in neuroscience. She received her master’s degree from The Ohio State University in 2013, where she studied clinical neuroscience within an integrative health program. Her specialized area of research involves the complementary use of neuroimaging and neuropsychology-based methodologies to examine how lifestyle factors, such as physical activity and meditation, can influence brain plasticity and enhance overall connectivity.

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