Exogen Therapy for the Treatment of Non-unions: A Single-Centre UK Experience

Non-unions are an important complication with significant costs to patients' quality of life as well as the healthcare system. Low-intensity pulsed ultrasound (LIPUS) is a promising modality as a low-risk and lower-cost alternative to revision surgery. We analysed the efficacy of LIPUS using Exogen® device in treating non-unions arising from traumatic fractures, osteotomies, and fusion procedures.

Patients who underwent Exogen therapy were identified from the local device registry and data were collected retrospectively from patient records. 44 patients with 46 non-unions were included in the final analysis. The primary outcome assessed was clinical and radiological healing. Secondary outcomes assessed included the correlation of healing with patient comorbidities, fracture characteristics, time gaps, and duration of therapy.

Union was achieved in 54.4% (25/46) of cases: 57.6% (19/33) arising from fractures and 46.2% (6/13) arising secondary to osteotomies or joint fusions. There was a significant correlation of success with Exogen when the underlying site was fixed with plating vis-à-vis nailing. No significant correlation was discovered with other assessed variables.

LIPUS offers a safer and non-invasive alternative to revision surgery in selected cases of established non-union. Our outcomes (54.4% success rate) fall short of the success rates with Exogen according to NICE (National Institute for Health and Care Excellence, UK) medical guidance and systematic review. However, it is in line with more recently published studies of single-centre experiences. More research is needed directly comparing Exogen vis-à-vis revision surgery to make more confident assertions.

The online version contains supplementary material available at https://doi.org/10.1007/s43465-026-01771-9.