Pulsed electromagnetic fields in orthopedics: mechanisms, evidence, and clinical use
Abstract
Pulsed electromagnetic fields (PEMFs) are non-invasive biophysical stimuli used in orthopedics, but clinical efficacy varies markedly by indication and device. This critical review integrates mechanistic, preclinical and clinical evidence identified through a structured search updated to 16 July 2026. PEMFs can modulate calcium-dependent signaling, adenosine receptors, nitric oxide, MAPK/ERK and Wnt/β-catenin pathways, with downstream effects on osteogenesis, inflammation and angiogenesis. The most defensible clinical applications are selected mechanically stable, aseptic delayed unions or non-unions and patients at increased risk of spinal pseudarthrosis. Routine use after an uncomplicated acute fracture is unsupported. In osteoarthritis, benefits are heterogeneous, generally modest and time dependent, without convincing evidence of cartilage regeneration or durable structural modification. Evidence for osteoporosis, osteochondral disease, soft-tissue repair, rehabilitation and infection-related applications remains preliminary. PEMF should therefore be used as a selective adjunct after correction of mechanical, infectious, metabolic and rehabilitative factors, with device-specific dosing, adherence monitoring and predefined outcomes.
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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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© © Ortopedici Traumatologi Ospedalieri d’Italia (O.T.O.D.i.) , 2026
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