A Randomized Placebo Controlled Trial Investigating the Efficacy of Pulsed Electromagnetic Field Therapy versus sham Therapy as an Adjunct to Conventional Physiotherapy on Pain, functional Disability, and quality of life in patients undergoing total hip arthroplasty

A Randomized Placebo Controlled Trial Investigating the Efficacy of Pulsed Electromagnetic Field Therapy versus sham Therapy as an Adjunct to Conventional Physiotherapy on Pain, functional Disability, and quality of life in patients undergoing total hip arthroplasty | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Randomized Placebo Controlled Trial Investigating the Efficacy of Pulsed Electromagnetic Field Therapy versus sham Therapy as an Adjunct to Conventional Physiotherapy on Pain, functional Disability, and quality of life in patients undergoing total hip arthroplasty Aachal Rambhau Gharjare, Mitushi Deshmukh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6528494/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 20 Feb, 2026 Read the published version in Trials → Version 1 posted 5 You are reading this latest preprint version Abstract Background The most popular surgical treatment for end-stage hip joint arthritis is total hip arthroplasty (THA). The main problems that occur after THA are pain, functional disability and reduced quality of life. The primary rehabilitation programmed for post-THA is conventional physiotherapy, but there is growing interest in complementary therapies that could hasten recovery and enhance results. Pulsed Electromagnetic Field therapy (PEMF) is a non-invasive treatment that reduces pain, promotes tissue repair, and may improve musculoskeletal outcomes. However, its effectiveness in THA patients is yet unknown, especially in comparison to sham PEMF therapy. Methods A 1:1 random assignment will allocate participants who have undergone total hip arthroplasty to receive active PEMF therapy or sham PEMF therapy in conjunction with conventional physiotherapy. Participants will be evaluated before and after the intervention and administered during a predetermined time frame. The primary outcomes will be a visual analogue scale and a Harris hip score for assessing postoperative pain and functional impairment. The secondary outcome will consist of an SF-36 questionnaire to evaluate quality of life and patient satisfaction. Additionally, safety and compliance with the intervention will be observed throughout the study. Discussion The purpose of this study is to investigate the possible impact of combining traditional physiotherapy with pulsed electromagnetic field therapy after total hip replacement. Trial registration CTRI No. CTRI/2025/03/083475. Registered on 26 March 2025. Total hip arthroplasty postoperative pain pulsed electromagnetic field therapy functional impairment quality of life sham therapy and physiotherapy Randomized placebo-controlled experiment Administrative Information Title {1} A Randomized Placebo Controlled Trial Investigating the Efficacy of Pulsed Electromagnetic Field Therapy versus sham Therapy as an Adjunct to Conventional Physiotherapy on Pain, functional Disability, and quality of life in patients undergoing total hip arthroplasty . Trial registration {2a and 2b}. CTRI No.: CTRI/2025/03/083475. Registered on 26 March 2025 Protocol version {3} - Funding {4} No Funding Author details {5a} 1st - Dr. Aachal Gharjare, Junior Resident, Department of Musculoskeletal Sciences Physiotherapy, DMIHER 2 nd - Dr. Mitushi Deshmukh, Associate Professor, Department of Musculoskeletal Sciences Physiotherapy, DMIHER Name and contact information for the trial sponsor {5b} - Role of sponsor {5c} - Introduction Background and rationale {6a} Total hip arthroplasty is one of the most common surgeries performed in the Indian population for hip diseases. The primary reason for this procedure is a disease known as avascular necrosis (AVN) of the femoral head, which occurs in approximately 51.8% of cases.1 Despite the fact that the operation was successful, many of them nevertheless feel pain, discomfort, and limited functional activity during recovery period.2 For total hip arthroplasty rehabilitation, traditional physiotherapy techniques like quadriceps strengthening, supine hip abductor and gluteal strengthening, sit-to-stand training, gait training with walking aid are frequently recommended. 3 Even while these techniques are usually successful, it may not always be enough to fully reduce pain and daily function. Pulsed electromagnetic field (PEMF) therapy is a non-invasive treatment modality that uses electromagnetic waves to promote healing and reduce inflammation. It has shown that due its great efficacy and few considerations, PEMF has a lot of potentials to become complementary strategies for treating various musculoskeletal conditions.4 Some research suggests that PEMF therapy may enhance outcomes such as pain alleviation, functional ability, and quality of life following THA surgery.4 However, there is insufficient high-quality evidence to support its advantages, particularly when contrasted to a placebo- treatment (sham PEMF). Despite increased interest in pulsed electromagnetic field (PEMF) therapy, no high-quality randomized controlled trials have been conducted to evaluate actual PEMF therapy to sham 0(placebo) PEMF in persons recuperating from total hip arthroplasty. The impact on pain, physical function, and quality of life remain unknown. Objectives {7} The objective of this study is to evaluate the impact of pulsed electromagnetic field (PEMF) therapy and sham PEMF therapy on pain reduction in patients undergoing total hip arthroplasty (THA) utilizing visual-analogue and to compare the effectiveness of PEMF therapy against sham therapy on functional impairment in post-THA patients using the Haris-Hip score and on the quality of life of patients recovering from THA using SF-36. Trial design {8} This study is designed as a randomized, placebo-controlled, parallel-group trial with outcome assessor blinding. Participants will be randomly assigned to one of two intervention groups-either the pulsed electromagnetic field (PEMF) therapy along with conventional physiotherapy or sham PEMF along with the conventional physiotherapy group. The trial will be conducted over a period of three weeks, with pre- and post-intervention assessments to evaluate changes in hand grip strength, pain levels, functional ability and core strength. Blinding will be maintained for the outcome assessors to reduce bias and ensure the reliability of the results. Methods: Participants, interventions and outcomes Study setting {9} The study will be carried out in the Musculoskeletal Physiotherapy Outpatient Department at Acharya Vinoba Bhave Rural Hospital, plasty ward no. 33 at Shalinitai Multispeciality Hospital, Datta Meghe Institute of Higher Education & Research (DU) Sawangi, Meghe Wardha, and schools in Wardha, Maharashtra, India, with the intervention beginning in May 2025. Eligibility criteria {10} Inclusion criteria 1.Age group between 18 to 70 years 2. Both Male and Female 3. Patients who underwent operation of the hip joint and without any other comorbidity Exclusion criteria 1. Active infections or open wounds around the hip joint. 2. Subjects with diabetes, peripheral neuropathy, renal issues, and subjects with post-surgery thrombophlebitis. 3. Pregnancy (due to potential risks with electromagnetic fields or electrical stimulation) Who will take informed consent? {26a} The Principal Investigator (PI) will take the informed consent. Additional consent provisions for collection and use of participant data and biological specimens {26b} Not Applicable. Rationale: - Principal Investigator will collect the consent from the subjects no additional consent is needed. This protocol doesn’t involve biological specimens as part of the process. Interventions Explanation for the choice of comparators {6b} PEMF Therapy: PEMF is a non-invasive procedure that may help with tissue repair, pain management, and better musculoskeletal results. The actual efficacy of this is still unknown in the context of post-THA rehabilitation. Sham Therapy as Comparator: To account for the placebo effect and guarantee that any effects are attributable to the active electromagnetic intervention and not to contextual or psychological variables, a sham (placebo) PEMF group is necessary. Intervention description {11a} Group A: PEMF and conventional physiotherapy Exercise Procedure Dosage PEMF therapy Patient in supine/semi-reclined position, and device will be placed over surgical site 4-5 times per week per 2 week, 30 minutes/session Magnetic field intensity: 1.5±0.1 mT Frequency: 75Hz Gait training Walking with walker or crutches, weight bearing as tolerated Daily as tolerated Hip ROM exercise Active and passive hip flexion, extension and abduction in supine or side lying position 10 reps × 2set, twice a day Strengthening Exercises Isometrics for quads, glutes and hams 10 reps × 2set, twice a day Functional training Sit-to-stand, bed mobility, stair climbing Daily 5-10 minutes Balance exercise Toe/heel lifts, heel-toe walking, step-ups with operated leg 10min/day, 4-5 times a week Breathing exercise Diaphragmatic breathing 5-10 mins/ session Group B: Sham PEMF and conventional Exercise Procedure Dosage Sham PEMF therapy (The device is off (placebo), but the setting is the same as for active PEMF.) Patient in supine/semi-reclined position, and device will be placed over surgical site 4-5 times per week per 2 week, 30 minutes/session Gait training Walking with walker or crutches, weight bearing as tolerated Daily as tolerated Hip ROM exercise Active and passive hip flexion, extension and abduction in supine or side lying position 10 reps × 2set, twice a day Strengthening Exercises Isometrics for quads, glutes and hams 10 reps × 2set, twice a day Functional training Sit-to-stand, bed mobility, stair climbing Daily 5-10 minutes Balance exercise Toe/heel lifts, heel-toe walking, step-ups with operated leg 10min/day, 4-5 times a week Breathing exercise Diaphragmatic breathing 5-10 mins/ session Criteria for discontinuing or modifying allocated interventions {11b} The intervention may be shortened, halted, or reduced if a person suffers from severe negative consequences, side effects, or injury as a result of it. The protocol should specify the criteria for a substantial adverse event as well as the evaluation and decision-making procedures Strategies to improve adherence to interventions {11c} Education and Demonstration of Participants: At the beginning of the study, participants will get clear instructions and inform them of the importance of the intervention and its potential benefits. Through discussions about informed consent, restate expectations and address participant questions. Supervised Sessions: To guarantee proper technique and promote participation, interventions will be given or overseen by a principal investigator while the participants are in the hospital. Relevant concomitant care permitted or prohibited during the trial {11d} Permitted Concomitant Care- Standard Postoperative care according to the hospital. Conventional Physiotherapy Exercise according to the protocol in both the groups. Regular medications and proper wound care which were prescribed to postoperative patients Prohibited Concomitant Care- No other Physical therapy Modalities. Participants with active or open wounds do not get associated therapies. Treatments connected to diabetes, peripheral neuropathy, renal problems, or post-surgery thrombophlebitis are not relevant throughout the experiment Provisions for post-trial care {30} After the trial intervention time is over, participants won't have access to PEMF therapy going forward. Any health problems associated with the intervention that may arise during or after the trial will be evaluated and treated in accordance with established hospital protocols. Participants who suffer negative consequences as a result of the study will receive the proper medical attention or, if necessary, be referred for a professional evaluation. Outcomes {12} Primary outcome measures: 1.The Visual Analog Scale (VAS) a 10-point scale ranging from "no pain" to "worst pain imaginable," will be used to quantify postoperative pain in those undergoing total hip arthroplasty. The VAS has shown great reliability in adult orthopedic populations, with a Cronbach's alpha of 0.94 [12]. Its good convergent validity is supported by a high correlation (r = 0.89) with other standardized pain assessment measures, proving its effectiveness in evaluating pain severity after surgical treatments such as THA. 2.Harris Hip Score (HHS) is a technique for assessing hip function, discomfort, and mobility in patients having total hip arthroplasty. It assesses domains such as pain, function, deformity, and range of motion to provide a complete picture of postoperative recovery. Recent research has established the HHS's reliability and validity in THA populations. For example, a study of the Arabic version of the HHS found a Cronbach's alpha of 0.742 after normalization, indicating acceptable internal consistency. Furthermore, the HHS had a good connection (r = 0.71) with the SF-36 health survey, indicating convergent validity. Secondary outcome measure: 1.The 36-Item Short Form Health Survey (SF-36) is a commonly used tool for assessing health-related quality of life (HRQoL) in a variety of patient populations, including those following total hip arthroplasty. It consists of eight domains: physical functioning, role constraints owing to physical health, physiological discomfort, general health perceptions, vitality, social functioning, role limitations due to emotional difficulties, and mental health. In the context of THA, the SF-36 has shown strong psychometric characteristics. Mariconda et al. (2011) investigated the long-term results of 250 patients who received THA, using the SF-36 and other metrics. The study found that, 16 years after surgery, patients reported SF-36 physical component scores that, while lower than normative values, were higher than those of untreated persons with severe hip osteoarthritis. This highlights the SF-36's sensitivity in detecting changes in HRQoL over extended periods after THA.14 Participant timeline {13} Sample size {14} For the sample size calculation, G*Power (version 3.1.9.4, Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany), was used based was used based on Visual analogue scale on relevant data, which represents the target population of this trial, with an effect size of 0.42, a significance level of 5% (alpha = 0.05), and power of 95% (1-β = 0.95). 2 The total sample size calculated was 74 participants, with 37 participants allocated to each group. Considering a potential dropout rate of 10%, an additional 8 participants were included, resulting in a final sample size of 90 participants—45 in each group. Recruitment {15} Clinical trial recruitment involves the screening of patients in Shalinitai Mult speciality Hospital, Plasty Ward, identifying eligible participants who fulfils the eligibility criteria (inclusion and exclusion criteria) and with written informed permission from willing participants. Assignment of interventions: allocation Sequence generation {16a} Participants will be randomly assigned to either the PEMF with conventional physiotherapy group or Sham PEMF with Conventional Physiotherapy group in a 1:1 ratio. The randomization sequence is created using computer-based random number generator to ensure unpredictability and reduce selection bias in clinical trials. Concealment mechanism {16b} Allocation concealment is done with the Sealed Opaque Numbered Envelope (SNOSE) method. An independent researcher prepares and securely stores envelopes with group assignments to avoid tampering or early disclosure, which helps maintain the randomization process's integrity. Implementation {16c} After baseline assessments, another independent staff member opens the next envelope to reveal the participant's group allocation and notifies the therapist. This separation of roles ensures that neither the recruiters nor the therapists can influence the randomization process, further reducing bias. Assignment of interventions: Blinding Who will be blinded {17a} The study uses a single-blinded design. The outcome assessor is blinded to group allocation to minimize assessment bias, while therapists and participants cannot be blinded due to the nature of the interventions. Therapists are not involved in outcome assessment or data analysis, and participants are instructed not to reveal their group to the assessor. This approach helps maintain objectivity in outcome measurement despite the practical limitations of blinding in physiotherapy trials. Plans for assessment and collection of outcomes {18a} Baseline Assessment: Before giving any intervention, data will be collected from subjects at the beginning including pain, functional status and quality of life. Post-Intervention Assessment: After the second week of intervention, right after the intervention period, data will be gathered once again. Plans to promote participant retention and complete follow-up {18b} Daily Follow-Up: To keep subjects engaged and track adherence, they will be contacted every day throughout the intervention period. Pre- and Post-Intervention Assessments: Clear checkpoints for retention and result measurement are provided by the data collection at baseline and at the conclusion of the intervention (end of week 2). Data management {19} The frequency percentage for qualitative data and the mean and standard deviation for quantitative data will be used to summarize the information acquired. Confidentiality {27} Any information pertaining to the subjects participating in the study shall be maintained confidential. Any patient-related information will only be used with due permission from the subjects. Plans for collection, laboratory evaluation and storage of biological specimens for genetic or molecular analysis in this trial/future use {33} Not Applicable Rationale: - The study focused on evaluating the effect of Pulsed electromagnetic field therapy using established scales, the methodology of this protocol only focuses on clinical and patient-reported outcomes, including pain, functional disability, quality of life and thus no biological specimens or genetic molecular testing is required. Statistical methods Statistical methods for primary and secondary outcomes {20a} Data will be analyzed using SPSS or similar statistical software. Descriptive statistics (mean, standard deviation, frequency, percentage) will summarize baseline characteristics. For within-group comparisons (pre- vs post-intervention), paired t-tests will be used for normally distributed data, or Wilcoxon signed-rank tests if normality is not met. Between-group comparisons will use independent t-tests for normally distributed variables, or the Mann–Whitney U test otherwise. For ordinal functional scores, non-parametric tests such as the Chi-square or Mann–Whitney U test will be applied as appropriate. A p-value < 0.05 will be considered statistically significant. These methods collectively ensure robust randomization, proper concealment, and objective assessment, which are essential for reducing bias and generating reliable evidence in clinical trials. Interim analyses {21b} Not Applicable. Rationale: After every participant has finished the intervention and follow-up periods, all analyses, including the evaluation of primary and secondary outcomes, are scheduled to take place. Methods for additional analyses (e.g. subgroup analyses) {20b} Not Applicable. Rationale: Wilcoxon signed-rank tests or pairwise t-tests for within-group comparisons (pre- vs. post-intervention) Independent t-tests or Mann-Whitney U tests for between-group comparisons (post-intervention outcomes) Methods in analysis to handle protocol non-adherence and any statistical methods to handle missing data {20c} Not Applicable. Rationale: - According to this protocol the procedure does not specify any plans or techniques for further studies, such as adjusted or subgroup analysis. Plans to give access to the full protocol, participant level-data and statistical code {31c} Not Applicable. For subjects that finish the research, the protocol mainly concentrates on pre- and post-intervention analyses, all analyses are designed for participants who finish the pre- and post-intervention questionnaires. Oversight and monitoring Full protocol: no clear strategy for public access outside of the criteria for publishing and trial registration. Participant level- data: No intention to share. Statistics code: No intention to share. Composition of the coordinating center and trial steering committee {5d} Coordinating centre: Location- The study is conducted in the Shalinitai Multispeciality Hospital, plasty Ward at the Datta Meghe Institute of Medical Sciences in Sawangi (Meghe), Wardha, Maharashtra, India. Role: Subject recruiting, eligibility screening, randomization, intervention delivery, data collecting, and data administration. Trial steering committee: Principal Investigator is in charge of participant enrollment, randomization, assignment to intervention groups, and overall study conduct. Physician oversees participant safety, handles unfavorable outcomes, and reports to the institutional ethics committee. The Ethical Committee oversees ethics and examines reports of undesirable events. Composition of the data monitoring committee, its role and reporting structure {21a} Safety Monitoring: Throughout the trial, the lead physician keeps an eye on, assesses, and handles any unintended consequences or adverse occurrences. Reporting: The Institutional Ethical Committee is notified of any unfavourable occurrences for additional monitoring and, if required, action. Ethical Oversight: The Institutional Ethical Committee makes sure that the trial is carried out in accordance with ethical guidelines and that subject safety is preserved. Adverse event reporting and harms {22} Pulsed Electromagnetic Field (PEMF) therapy and conventional physiotherapy are safe, non-invasive, easy to applicant and tolerated by patients with total hip arthroplasty. Some may experience warmth or tingling at the application site, but they are usually temporary and manageable after some time. No study indicates any adverse effect on implant fitting and wound concerns using PEMF. Adherence might be influenced by the duration and frequency of the sessions. The duration and frequency of the sessions. Overall, the intervention carries minimal risk when supervised properly. Frequency and plans for auditing trial conduct {23} Not Applicable. Rationale: - because of the non-invasive procedures, the study can be regarded as low risk and a small sample size which lessens the need for official auditing. Plans for communicating important protocol amendments to relevant parties (e.g. trial participants, ethical committees) {25} Our communication tactics for protocol revisions prioritize timely and direct dissemination of information to all relevant parties. This includes investigators, Research Ethics Committees, and Trial registries. We will provide timely dissemination of updates through streamlined communication channels, allowing stakeholders to stay informed and make necessary decisions. Dissemination plans {31a} The trial funding will be considered for publication. Participant data will be recorded anonymously, ensuring privacy. The trial results will improve existing guidelines and allow for the publication of new ones. Discussion In this randomized controlled trial, the efficacy of Pulsed Electromagnetic Field (PEMF) in conjunction with traditional physiotherapy in lowering pain and improving functional ability in patients after total hip arthroplasty was investigated. Effective pain management following THA is critical for early mobilization, optimal functional recovery, and increased patient satisfaction. However, there has been less research on the utility of PEMF in postoperative treatment for joint replacement. PEMF is a non-invasive treatment that is gaining popularity due to its potential as a replacement analgesic and reducing medication dependency. Many research studies have demonstrated the analgesic benefits of PEMF therapy in musculoskeletal ailments. Hackel et al. (2025) discovered that PEMF therapy significantly reduced pain in patients with joint and soft tissue injuries. PEMF therapy reduces pain by modifying pain pathways, improving blood circulation, and stimulating bone formation.16 Riccardo D'Ambrosi et al. (2022) recently showed that PEMF therapy significantly reduced pain in patients who had received unicompartmental knee arthroplasty. increasing the patients' rate of recovery and reaching their highest level of satisfaction. These findings showed that PEMF therapy is a useful alternative to analgesics for reducing postoperative pain. Nonetheless, research to standardize PEMF therapy is needed to address variations in its frequency and duration Trial status This is Protocol Version 1.0, dated 20 March 2025. The trial was registered under CTRI No.: CTRI/2025/03/083475 on 26 March 2025. Recruitment for participants began on 1 August 2025 and is estimated to be completed by 20 December 2025. Declarations Acknowledgements I would like to thank our DMIHER University for their contributions in this protocol Authors’ contributions {31b} 1 st author is the principal investigator (PI) and contributes to the study design and led the development of the protocol, will perform the data collection and data analysis while the 2 nd author will review. All author will approve the final manuscript Funding {4} Not Applicable. Availability of data and materials {29} Following the completion of the study, data will be published.” This indicates that the primary conclusions and summary result will be published. Ethics approval and consent to participate {24} This study is approved the institutional ethics committee of datta Institutional Ethical Committee meeting held on 30 th January 2025 has approved the proposed research work on 8 th February 2025. Ref.No.DMIHER(DU)/IEC/2025/618. Consent for publication {32} All personal data about the research participants will be kept private. Information about patients will only be used with consent granted by the individuals. Written consent is taken. Competing interests {28} The author declares no conflict of interest. Authors’ information (optional) 1 st Author: - Dr. Aachal Gharjare, Junior Resident, Department of Musculoskeletal Sciences Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (DU), Sawangi, Meghe, Wardha, Maharashtra, India -442001; [email protected] 2 nd Author: - Dr. Mitushi Deshmukh, Professor, Department of Musculoskeletal Sciences Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (DU), Sawangi, Meghe, Wardha, Maharashtra, India -442001 [email protected] References Yakkanti RR, Haziza S, Wasserman NA, Annapareddy A, Ratnakar V, Karri SR, Hernandez VH, Reddy AG, Vaishya R. Relative frequency of avascular necrosis of the hip as indication for primary Total Hip Arthroplasty in the USA vs. India. J Orthop. 2023;36:1–6. Ojoawo AO, Esan O, Oloni DA. Effectiveness of Transcutaneous Electrical Nerve Stimulation on Pain and Disability Among Patients with Hip Arthroplasty: A Randomized Control Study. Middle East J Rehabilitation Health Stud 2020;7(4). Coulter C, Perriman DM, Neeman TM, Smith PN, Scarvell JM. Supervised or unsupervised rehabilitation after total hip replacement provides similar improvements for patients: a randomized controlled trial. Arch Phys Med Rehabil. 2017;98(11):2253–64. Sharma S, Joshi S. Potential Use of Pulsed Electromagnetic Field in Musculoskeletal Disorders: A Narrative Review. J Dow Univ Health Sci (JDUHS). 2024;18(1). Helmy J, Valdebran M. An integrative review of pulsed electromagnetic field therapy (PEMF) and wound healing. Wound Pract Research: J Australian Wound Manage Association. 2024;32(2):58–65. Sharma S, Joshi S. Potential Use of Pulsed Electromagnetic Field in Musculoskeletal Disorders: A Narrative Review. 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Role of pulsed electromagnetic fields after joint replacements. World J Orthop. 2020;11(6):285. Sutbeyaz ST, Sezer N, Koseoglu BF. The effect of pulsed electromagnetic fields in the treatment of cervical osteoarthritis: a randomized, double-blind, sham-controlled trial. Rheumatol Int. 2006;26(4):320-4. 10.1007/s00296-005-0600-3 . Epub 2005 Jun 29. PMID: 15986086. Yavaş AD. Effect of pulsed electromagnetic field on pain, functionality and quality of life in the treatment of chronic non-specific low back pain: a randomized controlled trial. Int J Res Med Sci. 2023;11(10):3591–6. Hackel JG, Paci JM, Gupta S, Maravelas DA, North TJ, Paunescu A. Evaluating Noninvasive Pulsed Electromagnetic Field Therapy for Joint and Soft Tissue Pain Management: A Prospective, Multi-center, Randomized Clinical Trial. Pain Ther. 2025;14(2):723–35. Hackel JM, Paci S, Gupta DA, Maravelas TJ, North T, Paunescu A. Evaluating Noninvasive Pulsed Electromagnetic Field Therapy for Joint and Soft Tissue Pain: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study. Pain Ther. 2025;12(1):123–34. Adravanti P, Nicoletti S, Setti S, Ampollini A, de Girolamo L. Effect of pulsed electromagnetic field therapy in patients undergoing total knee arthroplasty: a randomised controlled trial. Int Orthop. 2014;38:397–403. Choubisa CA, Hege AR, Phansopkar P. Physiotherapy rehabilitation post total hip replacement in the case of avascular necrosis of the femur: A case report. Cureus. 2023;15(1). Cite Share Download PDF Status: Published Journal Publication published 20 Feb, 2026 Read the published version in Trials → Version 1 posted Reviewers agreed at journal 13 Aug, 2025 Reviewers invited by journal 13 Aug, 2025 Editor assigned by journal 27 Jul, 2025 First submitted to journal 26 Jul, 2025 Editorial decision: Minor revision 27 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6528494","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":500041358,"identity":"7ac85ca8-f357-4801-9fee-0b17012f4888","order_by":0,"name":"Aachal Rambhau Gharjare","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCklEQVRIiWNgGAWjYDACCSgGAjYGhgIbIM3YeIAELQZpIC0NhLUwILQcBrPwapGPbn72waLmnhx/++FnD34YnLdb234YaEuNTTQuLYZ3jhnPkDhWbCxxJs3csMfgdvK2M4lALcfSchtwaZmRYMwgwZYAVJbDJsED1GJ2AMhmbDiMR0v6ZwaJfwn188+/YZP8Y3Au2ez8Q/xa5CVyjBkk2xISDG7ksEnzGBywM7tBwBYDiZxiBsm+BMONN56ZScsYJCeY3QDakoDHL/Iz0jczS3xLkJc7n/xM8k2Fnb3Z+fSHDz7U2OC25QADAzNS3DAkglUm4FAOtgWogvEDkoA9HsWjYBSMglEwQgEAvNxg4qX35U4AAAAASUVORK5CYII=","orcid":"https://orcid.org/0009-0002-3125-8461","institution":"Datta Meghe Institute of Medical Sciences: Datta Meghe Institute of Higher Education \u0026 Research","correspondingAuthor":true,"prefix":"","firstName":"Aachal","middleName":"Rambhau","lastName":"Gharjare","suffix":""},{"id":500041359,"identity":"6576cc29-c311-4df5-8dd9-63da80dac0eb","order_by":1,"name":"Mitushi Deshmukh","email":"","orcid":"","institution":"Ravi Nair Physiotherapy College","correspondingAuthor":false,"prefix":"","firstName":"Mitushi","middleName":"","lastName":"Deshmukh","suffix":""}],"badges":[],"createdAt":"2025-04-25 11:26:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6528494/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6528494/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13063-026-09554-1","type":"published","date":"2026-02-20T15:58:40+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":103253074,"identity":"3b8c467e-b9b3-44aa-84b2-b47e1887feea","added_by":"auto","created_at":"2026-02-23 16:17:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1505810,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6528494/v1/cf6f5f50-a505-49cc-9dd8-56028ee58436.pdf"}],"financialInterests":"","formattedTitle":"A Randomized Placebo Controlled Trial Investigating the Efficacy of Pulsed Electromagnetic Field Therapy versus sham Therapy as an Adjunct to Conventional Physiotherapy on Pain, functional Disability, and quality of life in patients undergoing total hip arthroplasty","fulltext":[{"header":"Administrative Information","content":"\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eTitle {1}\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003eA Randomized Placebo Controlled Trial Investigating the Efficacy of Pulsed Electromagnetic Field Therapy versus sham Therapy as an Adjunct to Conventional Physiotherapy on Pain, functional Disability, and quality of life in patients undergoing total hip arthroplasty\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003e.\u003c/div\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eTrial registration {2a and 2b}.\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003eCTRI No.: CTRI/2025/03/083475. Registered on 26 March 2025\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eProtocol version {3}\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eFunding {4}\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003eNo Funding\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eAuthor details {5a}\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e1st - Dr. Aachal Gharjare, Junior Resident, Department of Musculoskeletal Sciences Physiotherapy, DMIHER\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003e2\u003csup\u003end\u003c/sup\u003e - Dr. Mitushi Deshmukh, Associate Professor, Department of Musculoskeletal Sciences Physiotherapy, DMIHER\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eName and contact information for the trial sponsor {5b}\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eRole of sponsor {5c}\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e-\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003cbr/\u003e"},{"header":"Introduction","content":"\u003cp\u003e\u003cstrong\u003eBackground and rationale {6a}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTotal hip arthroplasty is one of the most common surgeries performed in the Indian population for hip diseases. The primary reason for this procedure is a disease known as avascular necrosis (AVN) of the femoral head, which occurs in approximately 51.8% of cases.1 Despite the fact that the operation was successful, many of them nevertheless feel pain, discomfort, and limited functional activity during recovery period.2\u003c/p\u003e\n\u003cp\u003eFor total hip arthroplasty rehabilitation, traditional physiotherapy techniques like quadriceps strengthening, supine hip abductor and gluteal strengthening, sit-to-stand training, gait training with walking aid are frequently recommended. 3 Even while these techniques are usually successful, it may not always be enough to fully reduce pain and daily function.\u003c/p\u003e\n\u003cp\u003ePulsed electromagnetic field (PEMF) therapy is a non-invasive treatment modality that uses electromagnetic waves to promote healing and reduce inflammation. It has shown that due its great efficacy and few considerations, PEMF has a lot of potentials to become complementary strategies for treating various musculoskeletal conditions.4\u003c/p\u003e\n\u003cp\u003eSome research suggests that PEMF therapy may enhance outcomes such as pain alleviation, functional ability, and quality of life following THA surgery.4 However, there is insufficient high-quality evidence to support its advantages, particularly when contrasted to a placebo- treatment (sham PEMF).\u003c/p\u003e\n\u003cp\u003eDespite increased interest in pulsed electromagnetic field (PEMF) therapy, no high-quality randomized controlled trials have been conducted to evaluate actual PEMF therapy to sham 0(placebo) PEMF in persons recuperating from total hip arthroplasty. The impact on pain, physical function, and quality of life remain unknown.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives {7}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe objective of this study is to evaluate the impact of pulsed electromagnetic field (PEMF) therapy and sham PEMF therapy on pain reduction in patients undergoing total hip arthroplasty (THA) utilizing visual-analogue and to compare the effectiveness of PEMF therapy against sham therapy on functional impairment in post-THA patients using the Haris-Hip score and on the quality of life of patients recovering from THA using SF-36.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial design {8}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is designed as a randomized, placebo-controlled, parallel-group trial with outcome assessor blinding. Participants will be randomly assigned to one of two intervention groups-either the pulsed electromagnetic field (PEMF) therapy along with conventional physiotherapy or sham PEMF along with the conventional physiotherapy group. The trial will be conducted over a period of three weeks, with pre- and post-intervention assessments to evaluate changes in hand grip strength, pain levels, functional ability and core strength. Blinding will be maintained for the outcome assessors to reduce bias and ensure the reliability of the results.\u003c/p\u003e"},{"header":"Methods: Participants, interventions and outcomes","content":"\u003cp\u003e\u003cstrong\u003eStudy setting {9}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study will be carried out in the Musculoskeletal Physiotherapy Outpatient Department at Acharya Vinoba Bhave Rural Hospital, plasty ward no. 33 at Shalinitai Multispeciality Hospital, Datta Meghe Institute of Higher Education \u0026amp; Research (DU) Sawangi, Meghe Wardha, and schools in Wardha, Maharashtra, India, with the intervention beginning in May 2025.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEligibility criteria {10}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1.Age group between 18 to 70 years\u003c/p\u003e\n\u003cp\u003e2. Both Male and Female\u003c/p\u003e\n\u003cp\u003e3. Patients who underwent operation of the hip joint and without any other comorbidity\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. Active infections or open wounds around the hip joint.\u003c/p\u003e\n\u003cp\u003e2. Subjects with diabetes, peripheral neuropathy, renal issues, and subjects with post-surgery\u003c/p\u003e\n\u003cp\u003ethrombophlebitis.\u003c/p\u003e\n\u003cp\u003e3. Pregnancy (due to potential risks with electromagnetic fields or electrical stimulation)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWho will take informed consent? {26a}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Principal Investigator (PI) will take the informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdditional consent provisions for collection and use of participant data and biological specimens {26b}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003eRationale: - Principal Investigator will collect the consent from the subjects no additional consent is needed. This protocol doesn\u0026rsquo;t involve biological specimens as part of the process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterventions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExplanation for the choice of comparators {6b}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePEMF Therapy: PEMF is a non-invasive procedure that may help with tissue repair, pain management, and better musculoskeletal results. The actual efficacy of this is still unknown in the context of post-THA rehabilitation.\u003c/p\u003e\n\u003cp\u003eSham Therapy as Comparator: To account for the placebo effect and guarantee that any effects are attributable to the active electromagnetic intervention and not to contextual or psychological variables, a sham (placebo) PEMF group is necessary.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntervention description {11a}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGroup A: PEMF and conventional physiotherapy\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"499\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eExercise\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eProcedure\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eDosage\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003ePEMF therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003ePatient in supine/semi-reclined position, and device will be placed over surgical site\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e4-5 times per week per 2 week, 30 minutes/session\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMagnetic field intensity: 1.5\u0026plusmn;0.1 mT Frequency: 75Hz\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eGait training\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eWalking with walker or crutches, weight bearing as tolerated\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eDaily as tolerated\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eHip ROM exercise\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eActive and passive hip flexion, extension and abduction in supine or side lying position\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e10 reps \u0026times; 2set, twice a day\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eStrengthening Exercises\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eIsometrics for quads, glutes and hams\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e10 reps \u0026times; 2set, twice a day\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eFunctional training\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eSit-to-stand, bed mobility, stair climbing\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eDaily 5-10 minutes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eBalance exercise\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eToe/heel lifts, heel-toe walking, step-ups with operated leg\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e10min/day, 4-5 times a week\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eBreathing exercise\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eDiaphragmatic breathing\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e5-10 mins/ session\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eGroup B: Sham PEMF and conventional\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"499\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eExercise\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eProcedure\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eDosage\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u0026nbsp;Sham PEMF therapy\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(The device is off (placebo), but the setting is the same as for active PEMF.)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003ePatient in supine/semi-reclined position, and device will be placed over surgical site\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e4-5 times per week per 2 week, 30 minutes/session\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eGait training\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eWalking with walker or crutches, weight bearing as tolerated\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eDaily as tolerated\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eHip ROM exercise\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eActive and passive hip flexion, extension and abduction in supine or side lying position\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e10 reps \u0026times; 2set, twice a day\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eStrengthening Exercises\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eIsometrics for quads, glutes and hams\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e10 reps \u0026times; 2set, twice a day\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eFunctional training\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eSit-to-stand, bed mobility, stair climbing\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eDaily 5-10 minutes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eBalance exercise\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eToe/heel lifts, heel-toe walking, step-ups with operated leg\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e10min/day, 4-5 times a week\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eBreathing exercise\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eDiaphragmatic breathing\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e5-10 mins/ session\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCriteria for discontinuing or modifying allocated interventions {11b}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe intervention may be shortened, halted, or reduced if a person suffers from severe negative consequences, side effects, or injury as a result of it. The protocol should specify the criteria for a substantial adverse event as well as the evaluation and decision-making procedures\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrategies to improve adherence to interventions {11c}\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eEducation and Demonstration of Participants: At the beginning of the study, participants will get\u0026nbsp;clear instructions and inform them of the importance of the intervention and its potential benefits. Through discussions about informed consent, restate expectations and address participant questions.\u003c/li\u003e\n \u003cli\u003eSupervised Sessions: To guarantee proper technique and promote participation, interventions will be given or overseen by a principal investigator while the participants are in the hospital.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eRelevant concomitant care permitted or prohibited during the trial {11d}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePermitted Concomitant Care-\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eStandard Postoperative care according to the hospital.\u003c/li\u003e\n \u003cli\u003eConventional Physiotherapy Exercise according to the protocol in both the groups.\u003c/li\u003e\n \u003cli\u003eRegular medications and proper wound care which were prescribed to postoperative patients\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eProhibited Concomitant Care-\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eNo other Physical therapy Modalities.\u003c/li\u003e\n \u003cli\u003eParticipants with active or open wounds do not get associated therapies.\u003c/li\u003e\n \u003cli\u003eTreatments connected to diabetes, peripheral neuropathy, renal problems, or post-surgery thrombophlebitis are not relevant throughout the experiment\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eProvisions for post-trial care {30}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter the trial intervention time is over, participants won\u0026apos;t have access to PEMF therapy going forward. Any health problems associated with the intervention that may arise during or after the trial will be evaluated and treated in accordance with established hospital protocols. Participants who suffer negative consequences as a result of the study will receive the proper medical attention or, if necessary, be referred for a professional evaluation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcomes {12}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrimary outcome measures:\u003c/p\u003e\n\u003cp\u003e1.The Visual Analog Scale (VAS) a 10-point scale ranging from \u0026quot;no pain\u0026quot; to \u0026quot;worst pain imaginable,\u0026quot; will be used to quantify postoperative pain in those undergoing total hip arthroplasty. The VAS has shown great reliability in adult orthopedic populations, with a Cronbach\u0026apos;s alpha of 0.94 [12]. Its good convergent validity is supported by a high correlation (r = 0.89) with other standardized pain assessment measures, proving its effectiveness in evaluating pain severity after surgical treatments such as THA.\u003c/p\u003e\n\u003cp\u003e2.Harris Hip Score (HHS) is a technique for assessing hip function, discomfort, and mobility in patients having total hip arthroplasty. It assesses domains such as pain, function, deformity, and range of motion to provide a complete picture of postoperative recovery.\u003c/p\u003e\n\u003cp\u003eRecent research has established the HHS\u0026apos;s reliability and validity in THA populations. For example, a study of the Arabic version of the HHS found a Cronbach\u0026apos;s alpha of 0.742 after normalization, indicating acceptable internal consistency. Furthermore, the HHS had a good connection (r = 0.71) with the SF-36 health survey, indicating convergent validity.\u003c/p\u003e\n\u003cp\u003eSecondary outcome measure:\u003c/p\u003e\n\u003cp\u003e1.The 36-Item Short Form Health Survey (SF-36) is a commonly used tool for assessing health-related quality of life (HRQoL) in a variety of patient populations, including those following total hip arthroplasty. It consists of eight domains: physical functioning, role constraints owing to physical health, physiological discomfort, general health perceptions, vitality, social functioning, role limitations due to emotional difficulties, and mental health.\u003c/p\u003e\n\u003cp\u003eIn the context of THA, the SF-36 has shown strong psychometric characteristics. Mariconda et al. (2011) investigated the long-term results of 250 patients who received THA, using the SF-36 and other metrics. The study found that, 16 years after surgery, patients reported SF-36 physical component scores that, while lower than normative values, were higher than those of untreated persons with severe hip osteoarthritis. This highlights the SF-36\u0026apos;s sensitivity in detecting changes in HRQoL over extended periods after THA.14\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipant timeline {13}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\" width=\"313\" height=\"508\"\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size {14}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor the sample size calculation, G*Power (version 3.1.9.4, Heinrich Heine Universit\u0026auml;t D\u0026uuml;sseldorf, D\u0026uuml;sseldorf, Germany), was used based was used based on Visual analogue scale on relevant data, which represents the target population of this trial, with an effect size of 0.42, a significance level of 5% (alpha = 0.05), and power of 95% (1-\u0026beta; = 0.95). 2 The total sample size calculated was 74 participants, with 37 participants allocated to each group. Considering a potential dropout rate of 10%, an additional 8 participants were included, resulting in a final sample size of 90 participants\u0026mdash;45 in each group.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecruitment {15}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClinical trial recruitment involves the screening of patients in Shalinitai Mult speciality Hospital, Plasty Ward, identifying eligible participants who fulfils the eligibility criteria (inclusion and exclusion criteria) and with written informed permission from willing participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssignment of interventions: allocation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSequence generation {16a}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants will be randomly assigned to either the PEMF with conventional physiotherapy group or Sham PEMF with Conventional Physiotherapy group in a 1:1 ratio. The randomization sequence is created using computer-based random number generator to ensure unpredictability and reduce selection bias in clinical trials.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConcealment mechanism {16b}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAllocation concealment is done with the Sealed Opaque Numbered Envelope (SNOSE) method. An independent researcher prepares and securely stores envelopes with group assignments to avoid tampering or early disclosure, which helps maintain the randomization process\u0026apos;s integrity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplementation {16c}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter baseline assessments, another independent staff member opens the next envelope to reveal the participant\u0026apos;s group allocation and notifies the therapist. This separation of roles ensures that neither the recruiters nor the therapists can influence the randomization process, further reducing bias.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssignment of interventions: Blinding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWho will be blinded {17a}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study uses a single-blinded design. The outcome assessor is blinded to group allocation to minimize assessment bias, while therapists and participants cannot be blinded due to the nature of the interventions. Therapists are not involved in outcome assessment or data analysis, and participants are instructed not to reveal their group to the assessor. This approach helps maintain objectivity in outcome measurement despite the practical limitations of blinding in physiotherapy trials.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePlans for assessment and collection of outcomes {18a}\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eBaseline Assessment: Before giving any intervention, data will be collected from subjects at the beginning including pain, functional status and quality of life.\u003c/li\u003e\n \u003cli\u003ePost-Intervention Assessment: After the second week of intervention, right after the intervention period, data will be gathered once again.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003ePlans to promote participant retention and complete follow-up {18b}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDaily Follow-Up: To keep subjects engaged and track adherence, they will be contacted every day throughout the intervention period.\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003ePre- and Post-Intervention Assessments: Clear checkpoints for retention and result measurement are provided by the data collection at baseline and at the conclusion of the intervention (end of week 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData management {19}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe frequency percentage for qualitative data and the mean and standard deviation for quantitative data will be used to summarize the information acquired.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConfidentiality {27}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAny information pertaining to the subjects participating in the study shall be maintained confidential. Any patient-related information will only be used with due permission from the subjects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePlans for collection, laboratory evaluation and storage of biological specimens for genetic or molecular analysis in this trial/future use {33}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003eRationale: - The study focused on evaluating the effect of Pulsed electromagnetic field therapy using established scales, the methodology of this protocol only focuses on clinical and patient-reported outcomes, including pain, functional disability, quality of life and thus no biological specimens or genetic molecular testing is required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical methods for primary and secondary outcomes {20a}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData will be analyzed using SPSS or similar statistical software. Descriptive statistics (mean, standard deviation, frequency, percentage) will summarize baseline characteristics. For within-group comparisons (pre- vs post-intervention), paired t-tests will be used for normally distributed data, or Wilcoxon signed-rank tests if normality is not met. Between-group comparisons will use independent t-tests for normally distributed variables, or the Mann\u0026ndash;Whitney U test otherwise. For ordinal functional scores, non-parametric tests such as the Chi-square or Mann\u0026ndash;Whitney U test will be applied as appropriate. A p-value \u0026lt; 0.05 will be considered statistically significant. These methods collectively ensure robust randomization, proper concealment, and objective assessment, which are essential for reducing bias and generating reliable evidence in clinical trials.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInterim analyses {21b}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003eRationale: After every participant has finished the intervention and follow-up periods, all analyses, including the evaluation of primary and secondary outcomes, are scheduled to take place.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods for additional analyses (e.g. subgroup analyses) {20b}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003eRationale: Wilcoxon signed-rank tests or pairwise t-tests for within-group comparisons (pre- vs. post-intervention)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIndependent t-tests or Mann-Whitney U tests for between-group comparisons (post-intervention outcomes)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods in analysis to handle protocol non-adherence and any statistical methods to handle missing data {20c}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003eRationale: - According to this protocol the procedure does not specify any plans or techniques for further studies, such as adjusted or subgroup analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePlans to give access to the full protocol, participant level-data and statistical code {31c}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003eFor subjects that finish the research, the protocol mainly concentrates on pre- and post-intervention analyses, all analyses are designed for participants who finish the pre- and post-intervention questionnaires.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOversight and monitoring\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFull protocol: no clear strategy for public access outside of the criteria for publishing and trial registration.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParticipant level- data: No intention to share.\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003eStatistics code: No intention to share.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComposition of the coordinating center and trial steering committee {5d}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCoordinating centre:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLocation- The study is conducted in the Shalinitai Multispeciality Hospital, plasty Ward at the Datta Meghe Institute of Medical Sciences in Sawangi (Meghe), Wardha, Maharashtra, India.\u003c/p\u003e\n\u003cp\u003eRole: Subject recruiting, eligibility screening, randomization, intervention delivery, data collecting, and data administration.\u003c/p\u003e\n\u003cp\u003eTrial steering committee:\u003c/p\u003e\n\u003cp\u003ePrincipal Investigator is in charge of participant enrollment, randomization, assignment to intervention groups, and overall study conduct.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePhysician oversees participant safety, handles unfavorable outcomes, and reports to the institutional ethics committee.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe Ethical Committee oversees ethics and examines reports of undesirable events.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComposition of the data monitoring committee, its role and reporting structure {21a}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSafety Monitoring: Throughout the trial, the lead physician keeps an eye on, assesses, and handles any unintended consequences or adverse occurrences.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eReporting: The Institutional Ethical Committee is notified of any unfavourable occurrences for additional monitoring and, if required, action.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthical Oversight: The Institutional Ethical Committee makes sure that the trial is carried out in accordance with ethical guidelines and that subject safety is preserved.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdverse event reporting and harms {22}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePulsed Electromagnetic Field (PEMF) therapy and conventional physiotherapy are safe, non-invasive, easy to applicant and tolerated by patients with total hip arthroplasty. Some may experience warmth or tingling at the application site, but they are usually temporary and manageable after some time. No study indicates any adverse effect on implant fitting and wound concerns using PEMF. Adherence might be influenced by the duration and frequency of the sessions. The duration and frequency of the sessions. Overall, the intervention carries minimal risk when supervised properly.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFrequency and plans for auditing trial conduct {23}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003eRationale: - because of the non-invasive procedures, the study can be regarded as low risk and a small sample size which lessens the need for official auditing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePlans for communicating important protocol amendments to relevant parties (e.g. trial participants, ethical committees) {25}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur communication tactics for protocol revisions prioritize timely and direct dissemination of information to all relevant parties. This includes investigators, Research Ethics Committees, and Trial registries. We will provide timely dissemination of updates through streamlined communication channels, allowing stakeholders to stay informed and make necessary decisions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDissemination plans {31a}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe trial funding will be considered for publication. Participant data will be recorded anonymously, ensuring privacy. The trial results will improve existing guidelines and allow for the publication of new ones.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this randomized controlled trial, the efficacy of Pulsed Electromagnetic Field (PEMF) in conjunction with traditional physiotherapy in lowering pain and improving functional ability in patients after total hip arthroplasty was investigated. Effective pain management following THA is critical for early mobilization, optimal functional recovery, and increased patient satisfaction. However, there has been less research on the utility of PEMF in postoperative treatment for joint replacement. PEMF is a non-invasive treatment that is gaining popularity due to its potential as a replacement analgesic and reducing medication dependency.\u003c/p\u003e\u003cp\u003eMany research studies have demonstrated the analgesic benefits of PEMF therapy in musculoskeletal ailments. Hackel et al. (2025) discovered that PEMF therapy significantly reduced pain in patients with joint and soft tissue injuries. PEMF therapy reduces pain by modifying pain pathways, improving blood circulation, and stimulating bone formation.16\u003c/p\u003e\u003cp\u003eRiccardo D'Ambrosi et al. (2022) recently showed that PEMF therapy significantly reduced pain in patients who had received unicompartmental knee arthroplasty. increasing the patients' rate of recovery and reaching their highest level of satisfaction.\u003c/p\u003e\u003cp\u003eThese findings showed that PEMF therapy is a useful alternative to analgesics for reducing postoperative pain. Nonetheless, research to standardize PEMF therapy is needed to address variations in its frequency and duration\u003c/p\u003e\u003cp\u003e\u003cb\u003eTrial status\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis is Protocol Version 1.0, dated 20 March 2025. The trial was registered under CTRI No.: CTRI/2025/03/083475 on 26 March 2025. Recruitment for participants began on 1 August 2025 and is estimated to be completed by 20 December 2025.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI would like to thank our DMIHER University for their contributions in this protocol\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions {31b}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1\u003csup\u003est\u003c/sup\u003e author is the principal investigator (PI) and contributes to the study design and led the development of the protocol, will perform the data collection and data analysis while the 2\u003csup\u003end\u003c/sup\u003e author will review. All author will approve the final manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding {4}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials {29}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFollowing the completion of the study, data will be published.\u0026rdquo;\u0026nbsp;This indicates that the primary conclusions and summary result will be published.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate {24}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is approved the institutional ethics committee of datta\u0026nbsp;Institutional Ethical Committee meeting held on 30\u003csup\u003eth\u003c/sup\u003e January 2025 has approved the proposed research work on 8\u003csup\u003eth\u003c/sup\u003e February 2025.\u003c/p\u003e\n\u003cp\u003eRef.No.DMIHER(DU)/IEC/2025/618.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication {32}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll personal data about the research participants will be kept private. Information about patients will only be used with consent granted by the individuals. Written consent is taken.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests {28}\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author declares no conflict of interest.\u003cstrong\u003e\u003cbr\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003einformation (optional)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1\u003csup\u003est\u003c/sup\u003e Author: - Dr. Aachal Gharjare, Junior Resident, Department of Musculoskeletal Sciences Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (DU), Sawangi, Meghe, Wardha, Maharashtra, India -442001; [email protected]\u003c/p\u003e\n\u003cp\u003e2\u003csup\u003end\u003c/sup\u003e Author: - Dr. Mitushi Deshmukh, Professor, Department of Musculoskeletal Sciences Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research (DU), Sawangi, Meghe, Wardha, Maharashtra, India -442001 [email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eYakkanti RR, Haziza S, Wasserman NA, Annapareddy A, Ratnakar V, Karri SR, Hernandez VH, Reddy AG, Vaishya R. Relative frequency of avascular necrosis of the hip as indication for primary Total Hip Arthroplasty in the USA vs. India. J Orthop. 2023;36:1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOjoawo AO, Esan O, Oloni DA. Effectiveness of Transcutaneous Electrical Nerve Stimulation on Pain and Disability Among Patients with Hip Arthroplasty: A Randomized Control Study. Middle East J Rehabilitation Health Stud 2020;7(4).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCoulter C, Perriman DM, Neeman TM, Smith PN, Scarvell JM. Supervised or unsupervised rehabilitation after total hip replacement provides similar improvements for patients: a randomized controlled trial. Arch Phys Med Rehabil. 2017;98(11):2253\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSharma S, Joshi S. Potential Use of Pulsed Electromagnetic Field in Musculoskeletal Disorders: A Narrative Review. J Dow Univ Health Sci (JDUHS). 2024;18(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHelmy J, Valdebran M. An integrative review of pulsed electromagnetic field therapy (PEMF) and wound healing. Wound Pract Research: J Australian Wound Manage Association. 2024;32(2):58\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSharma S, Joshi S. Potential Use of Pulsed Electromagnetic Field in Musculoskeletal Disorders: A Narrative Review. J Dow Univ Health Sci (JDUHS). 2024;18(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCianni L, Di Gialleonardo E, Coppola D, Capece G, Libutti E, Nannerini M, Maccauro G, Vitiello R. Current Evidence Using Pulsed Electromagnetic Fields in Osteoarthritis: A Systematic Review. J Clin Med. 2024;13(7):1959.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCavalu S, et al. Assessment of pain intensity after total hip arthroplasty using the Visual Analogue Scale (VAS). J Med Life. 2024;17(12):1049\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlzahrani A, et al. Cross-Cultural Adaptation and Validation of the Arabic Version of the Harris Hip Score. Arthroplasty Today. 2022;8:100154.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSingh JA, et al. Clinically important improvement thresholds for Harris Hip Score and other measures in total hip arthroplasty. BMC Musculoskelet Disord. 2016;17:256.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMariconda M, Galasso O, Costa GG, Recano P, Cerbasi S. Quality of life and functionality after total hip arthroplasty. a long-term follow-up study; 2011.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLullini G, Cammisa E, Setti S, Sassoli I, Zaffagnini S, Muccioli GM. Role of pulsed electromagnetic fields after joint replacements. World J Orthop. 2020;11(6):285.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSutbeyaz ST, Sezer N, Koseoglu BF. The effect of pulsed electromagnetic fields in the treatment of cervical osteoarthritis: a randomized, double-blind, sham-controlled trial. Rheumatol Int. 2006;26(4):320-4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00296-005-0600-3\u003c/span\u003e\u003cspan address=\"10.1007/s00296-005-0600-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2005 Jun 29. PMID: 15986086.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYavaş AD. Effect of pulsed electromagnetic field on pain, functionality and quality of life in the treatment of chronic non-specific low back pain: a randomized controlled trial. Int J Res Med Sci. 2023;11(10):3591\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHackel JG, Paci JM, Gupta S, Maravelas DA, North TJ, Paunescu A. Evaluating Noninvasive Pulsed Electromagnetic Field Therapy for Joint and Soft Tissue Pain Management: A Prospective, Multi-center, Randomized Clinical Trial. Pain Ther. 2025;14(2):723\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHackel JM, Paci S, Gupta DA, Maravelas TJ, North T, Paunescu A. Evaluating Noninvasive Pulsed Electromagnetic Field Therapy for Joint and Soft Tissue Pain: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study. Pain Ther. 2025;12(1):123\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAdravanti P, Nicoletti S, Setti S, Ampollini A, de Girolamo L. Effect of pulsed electromagnetic field therapy in patients undergoing total knee arthroplasty: a randomised controlled trial. Int Orthop. 2014;38:397\u0026ndash;403.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChoubisa CA, Hege AR, Phansopkar P. Physiotherapy rehabilitation post total hip replacement in the case of avascular necrosis of the femur: A case report. Cureus. 2023;15(1).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"trials","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"trls","sideBox":"Learn more about [Trials](http://trialsjournal.biomedcentral.com/)","snPcode":"13063","submissionUrl":"https://www.editorialmanager.com/trls","title":"Trials","twitterHandle":"MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Total hip arthroplasty, postoperative pain, pulsed electromagnetic field therapy, functional impairment, quality of life, sham therapy, and physiotherapy Randomized, placebo-controlled experiment","lastPublishedDoi":"10.21203/rs.3.rs-6528494/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6528494/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe most popular surgical treatment for end-stage hip joint arthritis is total hip arthroplasty (THA). The main problems that occur after THA are pain, functional disability and reduced quality of life. The primary rehabilitation programmed for post-THA is conventional physiotherapy, but there is growing interest in complementary therapies that could hasten recovery and enhance results. Pulsed Electromagnetic Field therapy (PEMF) is a non-invasive treatment that reduces pain, promotes tissue repair, and may improve musculoskeletal outcomes. However, its effectiveness in THA patients is yet unknown, especially in comparison to sham PEMF therapy.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA 1:1 random assignment will allocate participants who have undergone total hip arthroplasty to receive active PEMF therapy or sham PEMF therapy in conjunction with conventional physiotherapy. Participants will be evaluated before and after the intervention and administered during a predetermined time frame. The primary outcomes will be a visual analogue scale and a Harris hip score for assessing postoperative pain and functional impairment. The secondary outcome will consist of an SF-36 questionnaire to evaluate quality of life and patient satisfaction. Additionally, safety and compliance with the intervention will be observed throughout the study.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDiscussion\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe purpose of this study is to investigate the possible impact of combining traditional physiotherapy with pulsed electromagnetic field therapy after total hip replacement.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTrial registration\u003c/b\u003e\u003c/p\u003e\u003cp\u003eCTRI No. CTRI/2025/03/083475. Registered on 26 March 2025.\u003c/p\u003e","manuscriptTitle":"A Randomized Placebo Controlled Trial Investigating the Efficacy of Pulsed Electromagnetic Field Therapy versus sham Therapy as an Adjunct to Conventional Physiotherapy on Pain, functional Disability, and quality of life in patients undergoing total hip arthroplasty","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-21 09:24:11","doi":"10.21203/rs.3.rs-6528494/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2025-08-13T14:54:52+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-13T14:44:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-27T10:38:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"Trials","date":"2025-07-26T11:11:27+00:00","index":"","fulltext":""},{"type":"decision","content":"Minor revision","date":"2025-06-27T04:00:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"trials","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"trls","sideBox":"Learn more about [Trials](http://trialsjournal.biomedcentral.com/)","snPcode":"13063","submissionUrl":"https://www.editorialmanager.com/trls","title":"Trials","twitterHandle":"MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dd47244e-3eb2-4b2f-9947-ecb022df6018","owner":[],"postedDate":"August 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-23T16:17:28+00:00","versionOfRecord":{"articleIdentity":"rs-6528494","link":"https://doi.org/10.1186/s13063-026-09554-1","journal":{"identity":"trials","isVorOnly":false,"title":"Trials"},"publishedOn":"2026-02-20 15:58:40","publishedOnDateReadable":"February 20th, 2026"},"versionCreatedAt":"2025-08-21 09:24:11","video":"","vorDoi":"10.1186/s13063-026-09554-1","vorDoiUrl":"https://doi.org/10.1186/s13063-026-09554-1","workflowStages":[]},"version":"v1","identity":"rs-6528494","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6528494","identity":"rs-6528494","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}