Advertisement

The perceptions of clinicians using low-intensity pulsed ultrasound (LIPUS) for orthopaedic pathology: A national qualitative study

      Highlights

      • A high proportion of LIPUS users lack full awareness of how the technology works
      • Clinicians perceive LIPUS as a cost effective tool for the treatment of non-union
      • There is no standardized way of using the LIPUS technology

      Abstract

      Introduction

      Low-intensity pulsed ultrasound (LIPUS) is a non-invasive treatment modality for delayed union or non-union of acute fractures. We aimed to assess the current use of LIPUS at a national level in the United Kingdom, why and how clinicians use it, what treatment protocols are followed, and what the current perceptions are on this technology.

      Methodology

      Using a detailed online survey compromised of 20 questions delivered to known LIPUS users, we were able to collect qualitative data on indication of use, type of machine used, personal views on the technology, frequency of usage, and treatment protocols. Each question was peer-reviewed to exclude bias.

      Results

      A total of 70 respondents completed the survey. LIPUS was used by most clinicians for cases of non-union (N = 55, 78.5%) and delayed union (N = 51, 72.8%). The majority of respondents personally used a LIPUS device between 1 and 5 times in 12 months (N = 38, 54.3%). Most considered LIPUS a failure after three to six months of treatment without clinical improvement (N = 39, 55.7%). A total of 32 respondents (45.7%) mentioned the need for funding approval before accessing LIPUS technology. Poor revision surgery candidates (N = 48, 68.6%) and atrophic non-union (N = 46, 65.7%) were the most frequently cited reasons for using LIPUS technology as treatment. Most participants (N = 48, 68.6%) considered LIPUS to be cost-effective. Despite most clinicians being comfortable with the use of LIPUS, some respondents did not understand the basic science underpinning the technology nor could explain the need for LIPUS to patients comfortably.

      Conclusion

      LIPUS technology may have a significant role to play in the treatment of orthopaedic fracture related pathology. Regular users perceived the technology to be cost-effective and efficacious. Further research should standardize treatment protocols and aim to establish a national LIPUS registry

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Leighton R
        • Watson JT
        • Giannoudis P
        • Papakostidis C
        • Harrison A
        • Steen RG.
        Healing of fracture nonunions treated with low-intensity pulsed ultrasound (LIPUS): A systematic review and meta-analysis.
        Injury. 2017; 48: 1339-1347
        • Bhandari M
        • Fong K
        • Sprague S
        • Williams D
        • Petrisor B.
        Variability in the definition and perceived causes of delayed unions and nonunions: a cross-sectional, multinational survey of orthopaedic surgeons.
        J Bone Joint Surg Am. 2012; 94: e1091-e1096
        • DeLong WG
        • Born CT
        • Wei SY
        • Petrik ME
        • Ponzio R
        • Schwab CW.
        Aggressive treatment of 119 open fracture wounds.
        J Trauma. 1999; 46: 1049-1054
        • Bell A
        • Templeman D
        • Weinlein JC.
        Nonunion of the Femur and Tibia: An Update.
        Orthop Clin North Am. 2016; 47: 365-375
        • Giannotti S
        • Bottai V
        • Dell'Osso G
        • Pini E
        • De Paola G
        • Bugelli G
        • et al.
        Current medical treatment strategies concerning fracture healing.
        Clin Cases Miner Bone Metab. 2013; 10: 116-120
        • Moon ES
        • Dy CJ
        • Derman P
        • Vance MC
        • Carlson MG.
        Management of nonunion following surgical management of scaphoid fractures: current concepts.
        J Am Acad Orthop Surg. 2013; 21: 548-557
        • Nandra R
        • Grover L
        • Porter K.
        Fracture non-union epidemiology and treatment.
        Trauma. 2016; 18: 3-11
        • Nolte PA
        • van der Krans A
        • Patka P
        • Janssen IM
        • Ryaby JP
        • Albers GH.
        Low-intensity pulsed ultrasound in the treatment of nonunions.
        J Trauma. 2001; 51 (discussion 702-703): 693-702
        • Tang C-H
        • Yang R-S
        • Huang T-H
        • Lu D-Y
        • Chuang W-J
        • Huang T-F
        • et al.
        Ultrasound stimulates cyclooxygenase-2 expression and increases bone formation through integrin, focal adhesion kinase, phosphatidylinositol 3-kinase, and Akt pathway in osteoblasts.
        Mol Pharmacol. 2006; 69: 2047-2057
        • Pilla AA
        • Mont MA
        • Nasser PR
        • Khan SA
        • Figueiredo M
        • Kaufman JJ
        • et al.
        Non-invasive low-intensity pulsed ultrasound accelerates bone healing in the rabbit.
        J Orthop Trauma. 1990; 4: 246-253
        • Harrison A
        • Lin S
        • Pounder N
        • Mikuni-Takagaki Y.
        Mode & mechanism of low intensity pulsed ultrasound (LIPUS) in fracture repair.
        Ultrasonics. 2016; 70: 45-52
        • Mundi R
        • Petis S
        • Kaloty R
        • Shetty V
        • Bhandari M.
        Low-intensity pulsed ultrasound: Fracture healing.
        Indian J Orthop. 2009; 43: 132-140
      1. EXOGEN Ultrasound Bone Healing System [Internet]. EXOGEN. 2019 [cited 2021 Jun 16]. Available from: https://www.exogen.com/

      2. NICE. Low-intensity pulsed ultrasound to promote healing of delayed-union and non-union fractures [Internet]. National Institute for Health and Care Excellence; 2018. Available from: https://www.nice.org.uk/guidance/ipg623/resources/lowintensity-pulsed-ultrasound-to-promote-healing-of-delayedunion-and-nonunion-fractures-pdf-1899873980963269

        • Higgins A
        • Glover M
        • Yang Y
        • Bayliss S
        • Meads C
        • Lord J.
        EXOGEN Ultrasound Bone Healing System for Long Bone Fractures with Non-Union or Delayed Healing: A NICE Medical Technology Guidance.
        Appl Health Econ Health Policy. 2014; 12: 477-484
        • NICE
        Report.
        2020: 1-28
      3. NICE. Low-intensity pulsed ultrasound to promote healing of fresh fractures at high risk of non-healing [Internet]. National Institute for Health and Care Excellence. NICE; 2021 [cited 2021 Jun 16]. Available from: https://www.nice.org.uk/guidance/ipg622

        • Romano CL
        • Romano D
        • Logoluso N.
        Low-Intensity Pulsed Ultrasound for the Treatment of Bone Delayed Union or Nonunion: A Review.
        Ultrasound Med Biol. 2009; 35: 529-536
        • Leighton R
        • Phillips M
        • Bhandari M
        • Zura R.
        Low intensity pulsed ultrasound (LIPUS) use for the management of instrumented, infected, and fragility non-unions: a systematic review and meta-analysis of healing proportions.
        BMC Musculoskelet Disord. 2021; 22: 532
        • Mehta S
        • Long K
        • DeKoven M
        • Smith E
        • Steen RG.
        Low-intensity pulsed ultrasound (LIPUS) can decrease the economic burden of fracture non-union.
        J Med Econ. 2015; 18: 542-549
        • Dijkman BG
        • Sprague S
        • Bhandari M.
        Low-intensity pulsed ultrasound: Nonunions.
        Indian J Orthop. 2009; 43: 141-148
        • Harrison A
        • Alt V.
        Low-intensity pulsed ultrasound (LIPUS) for stimulation of bone healing – A narrative review.
        Injury. 2021; 52: S91-S96
        • Busse JW
        • Bhandari M
        • Kulkarni AV
        • Tunks E.
        The effect of low-intensity pulsed ultrasound therapy on time to fracture healing: a meta-analysis.
        CMAJ Can Med Assoc J. 2002; 166: 437-441
        • Jingushi S
        • Mizuno K
        • Matsushita T
        • Itoman M.
        Low-intensity pulsed ultrasound treatment for postoperative delayed union or nonunion of long bone fractures.
        J Orthop Sci. 2007; 12: 35-41
        • Schandelmaier S
        • Kaushal A
        • Lytvyn L
        • Heels-Ansdell D
        • Siemieniuk RAC
        • Agoritsas T
        • et al.
        Low intensity pulsed ultrasound for bone healing: systematic review of randomized controlled trials.
        BMJ. 2017; 356: j656