{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T23:17:55Z","timestamp":1788391075556,"version":"build-2803163510"},"reference-count":28,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Knee osteoarthritis (OA) remains a leading cause of pain and disability, yet few nonoperative therapies have demonstrated durable clinical benefit or potential effects on structural disease progression. Pulsed electrical stimulation (PES) was investigated extensively over two decades, but this evidence has received little attention in the contemporary era of disease-modifying OA research. A structured evidence synthesis was performed of five principal prospective clinical investigations evaluating capacitively coupled PES for symptomatic knee OA. These included two randomized double-blind placebo-controlled trials, one multicenter phase IV investigation, one long-term observational study of arthroplasty deferral, and one histologic and radiographic study assessing structural cartilage changes. Collectively, the studies included 587 patients treated over more than 20 years. Clinical outcomes, functional improvement, medication utilization, safety, arthroplasty deferral, and structural findings were systematically reviewed and synthesized. Across investigations, PES consistently improved pain, physical function, physician and patient global assessments, and overall clinical status. Randomized controlled trials demonstrated significant improvements compared with placebo, while the multicenter phase IV study confirmed effectiveness in routine practice and identified a dose\u2013response relationship, with superior outcomes following greater cumulative treatment exposure. Approximately 45% of patients reduced nonsteroidal anti-inflammatory drug use by at least 50%, and nearly 60% of compliant patients previously advised to undergo total knee arthroplasty deferred surgery for 4 years or longer. Tissue characterization in one patient, supported by radiographic observations in five additional patients, suggested hyaline-like cartilage formation and increased compartmental joint-space width. There were no serious device-related adverse events reported. More than two decades of prospective evidence suggest that PES improves pain, function, patient-reported outcomes, and clinical status while maintaining an excellent safety profile. These findings support a contemporary reappraisal of this technology as a nonoperative joint-preservation strategy for symptomatic knee OA.<\/jats:p>","DOI":"10.1055\/a-2939-2499","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T22:46:56Z","timestamp":1788389216000},"source":"Crossref","is-referenced-by-count":0,"title":["Pulsed Electrical Stimulation for Knee Osteoarthritis: Reappraisal of a 21-Year Clinical Development Program"],"prefix":"10.1055","author":[{"given":"Michael A.","family":"Mont","sequence":"additional","affiliation":[{"name":"The Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Maryland, United States","place":["Baltimore"],"department":["Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8509-8120","authenticated-orcid":false,"given":"Chase W.","family":"Smitterberg","sequence":"additional","affiliation":[{"name":"The Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Maryland, United States","place":["Baltimore"],"department":["Department of Orthopaedic Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javad","family":"Parvizi","sequence":"additional","affiliation":[{"name":"Acibadem University Hospital, T\u00fcrkiye","place":["Istanbul"],"department":["International Joint Center"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Zizic","sequence":"additional","affiliation":[{"name":"Johns Hopkins School of Medicine, Maryland, United States","place":["Baltimore"],"department":["Department of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"1745","DOI":"10.1016\/S0140-6736(19)30417-9","article-title":"Osteoarthritis","volume":"393","author":"D J Hunter","year":"2019","journal-title":"Lancet"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1001\/jama.2020.22171","article-title":"Diagnosis and treatment of hip and knee osteoarthritis: a review","volume":"325","author":"J N Katz","year":"2021","journal-title":"JAMA"},{"issue":"06","key":"ref3","doi-asserted-by":"crossref","first-page":"1697","DOI":"10.1002\/art.34453","article-title":"Osteoarthritis: a disease of the joint as an organ","volume":"64","author":"R F Loeser","year":"2012","journal-title":"Arthritis Rheum"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.joca.2012.09.012","article-title":"Osteoarthritis as a disease of mechanics","volume":"21","author":"D T Felson","year":"2013","journal-title":"Osteoarthritis Cartilage"},{"issue":"11","key":"ref5","doi-asserted-by":"crossref","first-page":"1578","DOI":"10.1016\/j.joca.2019.06.011","article-title":"OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis","volume":"27","author":"R R Bannuru","year":"2019","journal-title":"Osteoarthritis Cartilage"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1002\/art.41142","article-title":"2019 American College of Rheumatology\/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee","volume":"72","author":"S L Kolasinski","year":"2020","journal-title":"Arthritis Rheumatol"},{"issue":"03","key":"ref7","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/j.joca.2014.01.003","article-title":"OARSI guidelines for the non-surgical management of knee osteoarthritis","volume":"22","author":"T E McAlindon","year":"2014","journal-title":"Osteoarthritis Cartilage"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1002\/acr.21596","article-title":"American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee","volume":"64","author":"M C Hochberg","year":"2012","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1038\/nrrheum.2010.178","article-title":"Pharmacologic therapy for osteoarthritis\u2013the era of disease modification","volume":"7","author":"D J Hunter","year":"2011","journal-title":"Nat Rev Rheumatol"},{"issue":"12","key":"ref10","doi-asserted-by":"crossref","first-page":"2013","DOI":"10.1016\/j.joca.2016.07.017","article-title":"Disease-modifying treatments for osteoarthritis (DMOADs) of the knee and hip: lessons learned from failures and opportunities for the future","volume":"24","author":"M A Karsdal","year":"2016","journal-title":"Osteoarthritis Cartilage"},{"issue":"04","key":"ref11","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1080\/14728214.2018.1547706","article-title":"Disease-modifying drugs in osteoarthritis: current understanding and future therapeutics","volume":"23","author":"W M Oo","year":"2018","journal-title":"Expert Opin Emerg Drugs"},{"issue":"06","key":"ref12","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1053\/joca.2002.0801","article-title":"Articular cartilage repair: basic science and clinical progress. A review of the current status and prospects","volume":"10","author":"E B Hunziker","year":"2002","journal-title":"Osteoarthritis Cartilage"},{"issue":"08","key":"ref13","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1016\/j.joca.2015.03.036","article-title":"Call for standardized definitions of osteoarthritis and risk stratification for clinical trials and clinical use","volume":"23","author":"V B Kraus","year":"2015","journal-title":"Osteoarthritis Cartilage"},{"key":"ref14","first-page":"487","article-title":"Articular cartilage: degeneration and osteoarthritis, repair, regeneration, and transplantation","volume":"47","author":"J A Buckwalter","year":"1998","journal-title":"Instr Course Lect"},{"issue":"03","key":"ref15","doi-asserted-by":"crossref","first-page":"460","DOI":"10.2106\/00004623-198264030-00022","article-title":"The response of articular cartilage to mechanical injury","volume":"64","author":"H J Mankin","year":"1982","journal-title":"J Bone Joint Surg Am"},{"key":"ref16","first-page":"277","volume-title":"Functional Tissue Engineering and the Role of Biomechanical Signaling in Articular Cartilage Repair","author":"F Guilak","year":"2003"},{"issue":"09","key":"ref17","first-page":"1757","article-title":"The treatment of osteoarthritis of the knee with pulsed electrical stimulation","volume":"22","author":"T M Zizic","year":"1995","journal-title":"J Rheumatol"},{"issue":"06","key":"ref18","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1016\/j.joca.2007.01.004","article-title":"A 3-month, randomized, double-blind, placebo-controlled study to evaluate the safety and efficacy of a highly optimized, capacitively coupled, pulsed electrical stimulator in patients with osteoarthritis of the knee","volume":"15","author":"D Garland","year":"2007","journal-title":"Osteoarthritis Cartilage"},{"key":"ref19","first-page":"227","article-title":"Pulsed electrical stimulation in patients with osteoarthritis of the knee: follow up in 288 patients who had failed non-operative therapy","volume":"15","author":"J Farr","year":"2006","journal-title":"Surg Technol Int"},{"issue":"10","key":"ref20","doi-asserted-by":"crossref","first-page":"887","DOI":"10.3928\/01477447-20061001-13","article-title":"Pulsed electrical stimulation to defer TKA in patients with knee osteoarthritis","volume":"29","author":"M A Mont","year":"2006","journal-title":"Orthopedics"},{"issue":"05","key":"ref22","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1097\/BOR.0b013e328349c2b1","article-title":"Inflammation in osteoarthritis","volume":"23","author":"M B Goldring","year":"2011","journal-title":"Curr Opin Rheumatol"},{"issue":"10","key":"ref23","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1038\/nrrheum.2012.113","article-title":"Recent advances in osteoarthritis imaging\u2013the osteoarthritis initiative","volume":"8","author":"F Eckstein","year":"2012","journal-title":"Nat Rev Rheumatol"},{"issue":"10","key":"ref24","doi-asserted-by":"crossref","first-page":"1804","DOI":"10.1136\/ard.2011.150243","article-title":"Presence of MRI-detected joint effusion and synovitis increases the risk of cartilage loss in knees without osteoarthritis at 30-month follow-up: the MOST study","volume":"70","author":"F W Roemer","year":"2011","journal-title":"Ann Rheum Dis"},{"issue":"10","key":"ref25","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1097\/00004424-200010000-00007","article-title":"Magic-angle effect in magnetic resonance imaging of articular cartilage: a review","volume":"35","author":"Y Xia","year":"2000","journal-title":"Invest Radiol"},{"issue":"05","key":"ref26","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1097\/BOR.0b013e328349c2d2","article-title":"Imaging of osteoarthritis: update from a radiological perspective","volume":"23","author":"A Guermazi","year":"2011","journal-title":"Curr Opin Rheumatol"},{"issue":"05","key":"ref27","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1038\/nrrheum.2017.50","article-title":"The role of metabolism in the pathogenesis of osteoarthritis","volume":"13","author":"A Mobasheri","year":"2017","journal-title":"Nat Rev Rheumatol"},{"issue":"04","key":"ref28","first-page":"e550","article-title":"A pulsed electrical joint stimulator for the treatment of osteoarthritis of the hand and wrist","volume":"41","author":"P A Holt","year":"2018","journal-title":"Orthopedics"},{"issue":"01","key":"ref29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/1097-0282(2001)62:1<1::AID-BIP10>3.0.CO;2-O","article-title":"FTIR microscopic imaging of collagen and proteoglycan in bovine cartilage","volume":"62","author":"N P Camacho","year":"2001","journal-title":"Biopolymers"}],"container-title":["The Journal of Knee Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2939-2499.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T22:47:05Z","timestamp":1788389225000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2939-2499"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,2]]},"references-count":28,"URL":"https:\/\/doi.org\/10.1055\/a-2939-2499","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1538-8506","1938-2480"],"issn-type":[{"value":"1538-8506","type":"print"},{"value":"1938-2480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,2]]}}}