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Review
. 2016 Aug 19:6:31724.
doi: 10.1038/srep31724.

Efficacy of Electrical Stimulators for Bone Healing: A Meta-Analysis of Randomized Sham-Controlled Trials

Ilyas S Aleem  1   2   3 , Idris Aleem  4 , Nathan Evaniew  1   2 , Jason W Busse  2   5   6 , Michael Yaszemski  7 , Arnav Agarwal  8 , Thomas Einhorn  9 , Mohit Bhandari  1   2
Affiliations
Review

Efficacy of Electrical Stimulators for Bone Healing: A Meta-Analysis of Randomized Sham-Controlled Trials

Ilyas S Aleem et al. Sci Rep. .

Abstract

Electrical stimulation is a common adjunct used to promote bone healing; its efficacy, however, remains uncertain. We conducted a meta-analysis of randomized sham-controlled trials to establish the efficacy of electrical stimulation for bone healing. We identified all trials randomizing patients to electrical or sham stimulation for bone healing. Outcomes were pain relief, functional improvement, and radiographic nonunion. Two reviewers assessed eligibility and risk of bias, performed data extraction, and rated the quality of the evidence. Fifteen trials met our inclusion criteria. Moderate quality evidence from 4 trials found that stimulation produced a significant improvement in pain (mean difference (MD) on 100-millimeter visual analogue scale = -7.7 mm; 95% CI -13.92 to -1.43; p = 0.02). Two trials found no difference in functional outcome (MD = -0.88; 95% CI -6.63 to 4.87; p = 0.76). Moderate quality evidence from 15 trials found that stimulation reduced radiographic nonunion rates by 35% (95% CI 19% to 47%; number needed to treat = 7; p < 0.01). Patients treated with electrical stimulation as an adjunct for bone healing have less pain and are at reduced risk for radiographic nonunion; functional outcome data are limited and requires increased focus in future trials.

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Conflict of interest statement

MB has received honorariums from Smith & Nephew, Stryker, Amgen, Zimmer, Moximed, Bioventus, Merck, Eli Lilly, Sanofi and research grants from Smith & Nephew, DePuy, Eli Lily, Bioventus, Stryker, Zimmer, Amgen; JWB was a co-principal investigator for a recently completed trial of a competing device (low intensity pulsed ultrasound) that received funding from an industry sponsor (Smith & Nephew); no other relationships or activities have influenced the submitted work.

Figures

Figure 1
Figure 1. Flow of articles included in the study.
Figure 2
Figure 2. Risk of bias summary: review authors’ judgments about each risk of bias item for included trials.
Green circles indicate low risk of bias and red circles indicate high risk of bias.
Figure 3
Figure 3. Funnel plot of Standard Error (log(relative risk)) against relative risk to assess for publication bias.
Figure 4
Figure 4. Pooled pain score (mean difference).
Figure 5
Figure 5. Pooled functional outcome data (mean difference).
Figure 6
Figure 6. Radiographic nonunion at last reported follow-up to 12 months with subgroups by indication.
See this image and copyright information in PMC

References

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