MODERATE RECOMMENDATION The Transcutaneous Electrical Nerve Stimulation recommendation has been downgraded one level because of inconsistent evidence.
Eight high quality (Kadi 2019, Gorodestskyi 2017, Ramanathan 2017, Feil 2011, Avramidis 2011, Izumi 2015, Forogh 2019, Rakel 2014) and three moderate quality (Goyal 2012, Lan 2012, Gorodetskyi 2010) studies were reviewed. Only one of these eleven studies reported improvements in function (over standard treatment), and two additional studies reported improvement in ROM. Only one moderate quality study reported reductions in opioid use. Three of nine studies reporting on pain outcomes showed improvement.
Benefits/Harms of Implementation
No studies reported adverse events and this technology is in widespread use. Risks appear to be low.
Cost Effectiveness/Resource Utilization
Transcutaneous electrical nerve stimulation (TENS) units are economical and may have low resource utilization in the hospital setting.
Future Research
Inconsistent results highlight the need for larger studies with an emphasis on heterogenous treatment effects, particularly around pain outcomes and cost effectiveness studies.
- Avramidis, K., Karachalios, T., Popotonasios, K., Sacorafas, D., Papathanasiades, A. A., Malizos, K. N. Does electric stimulation of the vastus medialis muscle influence rehabilitation after total knee replacement?. Orthopedics 2011; 3: 175
- Feil, S., Newell, J., Minogue, C., Paessler, H. H. The effectiveness of supplementing a standard rehabilitation program with superimposed neuromuscular electrical stimulation after anterior cruciate ligament reconstruction: a prospective, randomized, single-blind study. Am J Sports Med 2011; 6: 1238-47
- Forogh, B., Aslanpour, H., Fallah, E., Babaei-Ghazani, A., Ebadi, S. Adding high-frequency transcutaneous electrical nerve stimulation to the first phase of post anterior cruciate ligament reconstruction rehabilitation does not improve pain and function in young male athletes more than exercise alone: a randomized single-blind clinical trial. Disabil Rehabil 2019; 5: 514-522
- Gorodetskyi, I. G., Gorodnichenk, A. I., Tursin, O. P. S., Reshetnyak, V. K., Uskov, O. N. Non-invasive interactive neurostimulation in the post-operative recovery of patients with a trochanteric fracture of the femur: A randomised, controlled trial. Journal of Bone and Joint Surgery - Series B 2007; 11: 1488-1494
- Gorodetskyi, I. G., Gorodnichenko, A. I., Tursin, P. S., Reshetnyak, V. K., Uskov, O. N. Use of noninvasive interactive neurostimulation to improve short-term recovery in patients with surgically repaired bimalleolar ankle fractures: a prospective, randomized clinical trial. J Foot Ankle Surg 2010; 5: 432-7
- Goyal, A., Arora, S., Batra, S., Sharma, R., Mittal, M. K., Sharma, V. K. Role of calf muscle stimulation in the prevention of DVT in Indian patients undergoing surgeries for fractures around the hip. Indian J Orthop 2012; 5: 542-7
- Izumi, M., Ikeuchi, M., Aso, K., Sugimura, N., Kamimoto, Y., Mitani, T., Ueta, T., Sato, T., Yokoyama, M., Sugiura, T., Tani, T. Less deep vein thrombosis due to transcutaneous fibular nerve stimulation in total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2015; 11: 3317-23
- Kadi, M. R., Hepguler, S., Atamaz, F. C., Dede, E., Aydogdu, S., Aktuglu, K., Ozkayin, N., Ozturk, C. Is interferential current effective in the management of pain, range of motion, and edema following total knee arthroplasty surgery? A randomized double-blind controlled trial. Clin Rehabil 2019; 6: 1027-1034
- Lan, F., Ma, Y. H., Xue, J. X., Wang, T. L., Ma, D. Q. Transcutaneous electrical nerve stimulation on acupoints reduces fentanyl requirement for postoperative pain relief after total hip arthroplasty in elderly patients. Minerva Anestesiol 2012; 8: 887-95
- Rakel, B. A., Zimmerman, M. B., Geasland, K., Embree, J., Clark, C. R., Noiseux, N. O., Callaghan, J. J., Herr, K., Walsh, D., Sluka, K. A. Transcutaneous electrical nerve stimulation for the control of pain during rehabilitation after total knee arthroplasty: A randomized, blinded, placebo-controlled trial. Pain 2014; 12: 2599-611
- Ramanathan, D., Saleh, A., Klika, A. K., Higuera, C. A., Barsoum, W. K. The Use of Transcutaneous Electrical Nerve Stimulation After Total Knee Arthroplasty: A Prospective Randomized Controlled Trial. Surg Technol Int 2017; 0: 425-434