tDCS: Patient has right total knee arthroplasty (TKA) and total hip arthroplasty (THA), am I allowed to use tDCS – even peripherally with peripheral spinal stimulation?
… this is relevant for peripheral tDCS in cases of spinal injury where modulation is applied between the sole of the foot and the spine or brain.
Short answer: Yes, tDCS is generally permitted and considered safe for patients with total knee arthroplasty (TKA) and total hip arthroplasty (THA), provided certain guidelines are followed.
In detail, to maintain clinical clarity:
Basic Assessment
A total knee or hip replacement consists of:
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- titanium, cobalt-chromium, or similar alloys
- not electrically active
- not magnetic
- not electrically conductive in the sense of stimulation
tDCS operates with:
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- very low direct currents (typically 1–2 mA)
- surface current density
- primarily neuronal modulation, not tissue warming
There is no evidence that tDCS:
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- Heats up prostheses
- Displaces prostheses
- Causes electrolysis or corrosion of endoprostheses
tDCS is routinely used worldwide in patients with:
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- Third-degree knee replacement
- Third-degree hip replacement
- Spinal implants
- Screws, plates, osteosynthesis materials
… Important Safety Rules (Clinically Relevant)
No electrode directly over the prosthesis
No active electrode directly on:
Knee joint
Hip region/trochanter
Reason: local skin irritation and unnecessary current concentration, not due to the prosthesis itself
Lumbar cathode
Also permitted with hip replacement
Electrode: paraspinal or midline, not lateral directly over the hip joint
A knee or hip replacement is not a contraindication for tDCS. What is relevant is where and how you stimulate. – not that metal is present.
