Knee osteoarthritis (KOA) is a degenerative joint disorder, and its main clinical manifestations include pain, swelling, stiffness, and dysfunction [1]. Globally, approximately one-third of individuals aged > 45 years show radiographic signs of KOA [2]. Nearly half of these experience concomitant knee symptoms, contributing to diminished productivity in older people, which imposes a significant economic burden on society, with medical costs averaging over $10,000 throughout one’s lifetime [2]. In the absence of a definitive cure for KOA, treatment strategies prioritize pain management and functional restoration [3]. Initial, KOA management focuses on conservative therapies, such as exercise, weight reduction, and thermotherapy, whereas pharmacologic interventions with nonsteroidal anti-inflammatory drugs (NSAIDs), intraarticular hyaluronic acid, and corticosteroid injections are employed based on pain severity [3].

Acupuncture has emerged as a promising complementary therapy for KOA, demonstrating efficacy in alleviating pain, stiffness, and swelling and offering a potentially safer alternative to conventional approaches [4]. Acupuncture stimulation can be augmented by various physical stimuli, ranging from moxibustion and electroacupuncture to magnetic therapy. Although studies on magnetic stimulation has explored its application in the evaluation of the analgesic effect of acupuncture [5], muscle fatigue management [6-8], myofascial pain treatment [9], abdominal obesity treatment [10], and peripheral facial nerve palsy treatment [11], other studies on the use of acupuncture combined with magnetic stimulation specifically for KOA are currently lacking.

To address this literature gap, this case report presents clinical improvements in a patient with KOA after the application of magnetic acupuncture using the medical magnetic generator Whata 153 (Medi-Lab., Ltd.).

1. Case presentation

A 69-year-old Korean Buddhist nun (Bhikkhuni) was diagnosed with bilateral KOA (Kellgren–Lawrence grade 2). She experienced right knee joint pain starting in January 2022 and was admitted to the hospital with complaints of joint pain, swelling, and stiffness. The patient was hospitalized for treatment from March 26, 2024, to April 19, 2024. During her hospitalization, she received Korean medicine treatments, including acupuncture and pharmacopuncture. Electronic medical records were used to analyze patient data.

Written informed consent was obtained before study participation. This study was approved by the Institutional Review Board of the Pusan National University Korean Medical Hospital (PNUKH IRB No. 2024-05-003).

2. Treatment methods

1) Electromagnetic acupuncture

Electromagnetic acupuncture was performed daily during the patient’s hospitalization by a doctor of Korean medicine with > 20 years of experience in acupuncture. For this treatment, magnetized needles (0.30 × 60 mm, disposable sterilized stainless steel; SMC Co., Ltd.) were inserted at 12 acupoints, including ST34, ST35, ST36, GB34, SP9, SP10, EX-LE4, and Ashi points around the right knee at a depth of 2 cm (Fig. 1). A medical device (Whata 153) enhanced stimulation by generating a magnetic field by passing current through a cylindrical coil. The device’s rings were placed on the needles, applying an 80-Hz (interference wave) magnetic field to enhance stimulation for 20 minutes (Fig. 2).

Figure 1. Acupoints where electromagnetic acupuncture was administered.

Figure 2. (A) The Whata 153 (Medi-Lab., Ltd.). (B) A diagram of the coil for magnetization of the acupuncture needle. Current flow through the coil induces a magnetic field, and insertion of a magnetic material further enhances the magnetic field.

2) Pharmacopuncture

Pharmacopuncture was administered daily during hospitalization by a doctor of Korean medicine with > 20 years of experience in pharmacopuncture. The treatment used 7.5% Asiasari Radix et Rhizoma solution for pharmacopuncture (20 mL per vial) (Jayeonsaeng Tangjeonsil). A disposable needle (27 gauge × 60 mm; Sungshim Medical Co., Ltd.) and a 3-mL insulin syringe (Jungrim Medical Industrial Co., Ltd.) were used. Pharmacopuncture was injected intramuscularly at a dosage of 2 mL per point at the ST34, ST35, ST36, GB34, SP9, SP10, EX-LE4, and Ashi points around the right knee.

3. Evaluation

The numerical rating scale (NRS) quantifies the subjective severity of pain on a scale of 0–10, where scores of 10 and 0 represents the worst imaginable pain and a pain-free state, respectively [12]. The NRS score was assessed each morning at 7 am by an independent assessor.

The Korean language version of the Western Ontario and McMaster Universities Osteoarthritis Index (KWOMAC) is used to measure treatment outcomes in patients with lower extremity arthritis [13]. This self-administered questionnaire includes 24 questions divided into subscales of pain, stiffness, and physical function. Each subscale is rated on a five-point Likert scale, ranging from 0 (none) to 4 (extreme). Scores from each subscale are summed to a possible maximum of 96, providing a comprehensive assessment of the patient’s functional status and pain severity. Patient-filled KWOMAC questionnaires were collected at admission and discharge.

The patient’s global impression of change (PGIC) scale is a self-reported tool used to measure patients’ overall sense of improvement or worsening following an intervention [14]. This scale allows patients to express their perception of change by selecting one of seven categories, ranging from “very much improved” to “very much worse,” facilitating a nuanced interpretation of the treatment’s effect. The PGIC was collected at discharge.

4. Evaluation results

The patient experienced improvements in various symptoms during the hospital stay. Notably, the patient reported a reduction in intermittent stiff pain on the medial side of the right knee joint. Joint swelling and stiffness also improved. The NRS score decreased from 7 to 4. Changes in the NRS scores are shown in Fig. 3. The patient also reported gait improvement, with the duration of walk extending from 50 minutes to > 60 minutes.

Figure 3. Changes in the NRS score from admission to discharge. NRS, numerical rating scale.

Quantitatively, the improvement was reflected in the KWOMAC scores, which decreased from 20 at admission to 14 at discharge. On the PGIC, the patient rated the improvement as “significantly improved,” expressing overall satisfaction with the treatment received during the hospital stay.

South Korea’s rapidly aging population, reflected in a concerning 30.2% prevalence of KOA among individuals aged ≥ 65 years, is expected to exacerbate the burden of this degenerative joint disease, leading to a concomitant rise in associated social costs [15]. Conventional pain management strategies utilizing NSAIDs and opioids are a point of concern because of their long-term safety associations with hepatic, gastrointestinal, and renal complications and potential for overuse-induced joint degeneration [16,17]. Furthermore, current guidelines advise against the routine use of hyaluronic acid injections [18]; while intraarticular corticosteroid injections offer temporary pain relief, their repeated use necessitates caution because of the risk of cartilage damage [3].

Magnetic stimulation exploits the principle of electromagnetic induction to generate therapeutic effects within the body. Magnetic fields generate electrical currents that directly stimulate excitable tissues, including nerves and muscles. This approach offers targeted neuromodulation, potentially influencing neural activity patterns, blood flow, and cellular function. The supposed benefits include the restoration of electrical and magnetic homeostasis, enhancements of cellular magnetic capacity, and regulation of electrolyte balance, ultimately promoting healing and improving function [19,20]. Despite investigations into its effects, the ability of magnetic stimulation to modulate neural activity and restore physiological balance suggests that electromagnetic acupuncture could be a promising alternative approach for managing pain and dysfunction in KOA, where the repetitive inflammatory response remains a target for therapeutic intervention.

Magnetic field application to acupuncture stimulation generates bioelectric current without any external potential interference and penetrates vertically into the tissues. Continuous magnetic field stimulations on the needle may be expected to produce the de qi sensation of manual acupuncture by generating an electropotential similar to that produced manually [10,11].

Whata 153 uses an electromagnetic generator in delivering heat to the acupuncture needle. Similar to conventional warm- and fire-needle acupuncture, it generates a thermal effect on the needle through induced current. However, Whata 153 offers precise temperature control through a digital control system that allows the fine-tuning of the magnetic field strength with minimized burn risk. Unlike conventional techniques such as moxibustion, which is susceptible to temperature changes due to practitioner skill and environmental factors, Whata 153 ensures consistent thermal delivery for reproducible treatment outcomes.

This case report presents a single patient with KOA experiencing subjective improvements after treatment with electromagnetic acupuncture using Whata 153. However, the generalizability of these findings is limited by the inherent constraints of a case report and the lack of a control group and standardized outcome measures to assess the efficacy of this novel intervention for KOA. Furthermore, the concurrent use of pharmacopuncture in this report limits the ability to definitively attribute the observed improvements to electromagnetic acupuncture alone. Future studies utilizing controlled trials with larger sample sizes are warranted to establish the efficacy and safety of electromagnetic acupuncture for KOA. More studies are needed to elucidate the underlying mechanisms by which magnetic field stimulation combined with acupuncture may exert its therapeutic effects on KOA.

Conceptualization: GYY, GHA. Methodology: GYY, JK, TL. Formal investigation: JK, TL, SA. Data analysis: JK, TL. Funding acquisition: GYY. Writing – original draft: JK, TL. Writing – review & editing: YO, GYY.

The authors have no conflicts of interest to declare.

This work was supported by a 2-year research grant of Pusan National University.

Electronic medical records were used to analyze patient data, and written informed consent was obtained before study participation. The Institutional Review Board of the Pusan National University Korean Medical Hospital approved this study (PNUKH IRB No. 2024-05-003).