Knee Osteoarthritis Recommendations & Ruptured Breast Implants

The Chiropractic Forward Podcast: Evidence-based Chiropractic Advocacy

CF 343: Knee Osteoarthritis Recommendations & Ruptured Breast Implants Today we’re going to talk about Knee Osteoarthritis Recommendations & Ruptured Breast Implants But first, here’s that sweet sweet bumper music

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. I’m so glad you’re spending your time with us learning together. Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at [e-mail] If you haven’t yet I have a few things you should do.

• Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.
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• Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #343 Now if you missed last week’s episode, we talked about Cancer Vaccines & Cognitive Behavioral Therapy Make sure you don’t miss that info. Keep up with the class.

On the personal end of things…..

It’s a Monday as I sit and put my thoughts together. Just got back from the big One Voice Conference in Dallas. I took my son, Jake, who is 22. He had a big time and I think Voice over is his new love but we shall see. Getting back to work today and getting back in the swing of things now so let’s look at what’s on my plate this week. I had 50 on my personal chiro schedule today.

That made for quite a Monday. On top of that, we are still going through the process of changing out our medical provider and that’s been a chore for sure but of course, it would be. There is a reason the average run-of-the-mill chiro doesn’t do the integrated setup. It’s because it ain’t easy, folks. It’s just not. But, all of the heavy lifting is out of the way for us. We did all that 3 years ago. Now we just have to replace and hopefully maintain as much of the medical business as we possibly can. And the girl we have coming in is outstanding. If you listen a week or so ago, I said that I no longer fear change now that I’m 26 years into this deal. What kills me is uncertainty. I can’t have it.

So it’s not the change that gets me. It’s the middle ground. It’s the not knowing what the new normal is going to look like. It’s that middle gray area that works over my anxiety levels and my sleep schedule. So the faster I can get confident in what the change is and how it looks, the faster I can get back to fun boss. So that’s the main thing happening at my place lately. Just that big change and navigating the waters of it. And I think it’s looking really really good so far. I’m not going to waste time here. I don’t have a lot left to say. Let’s just jump in, shall we?

Item #1

Our first one this week is called, “Case Study: Ruptured Breast Implant Claim is a Bust” by NCMIC and published on their site base on a paper in Case Studies that was published on Wednesday, July 17, 2024 and you know we got a spicy saucy one today!

Remember, the citations can be found at chiropracticforward.com under this episode.

https://www.ncmic.com/resources/case-studies/case-study-ruptured-implant-claim-is-a-bust/?utm_source=ActiveCampaign&utm_medium=email&utm_content=Case+Study:+Breast+Implant+Claim+is+a+Bust&utm_campaign=July+Examiner&fbclid=IwY2xjawEXhUxleHRuA2FlbQIxMQABHWC76Qb-7vghWR58UcwLL9xhtVCxnmdsbmr6dNSZY0cUS5TT8MEnTiv9iA_aem_9kTK0RZdji9iQdqHkcLe7A

A 42-year-old CrossFit competitor named Mary Chase sought chiropractic treatment from Dr. Richardson for pain following a car accident. Chase had breast implants from a 2013 surgery. During a thoracic manipulation, Chase heard a “pop” and felt pain in her right breast. Dr. Richardson noted a possible ruptured implant. Chase later saw a plastic surgeon who confirmed a ruptured implant. She filed a malpractice lawsuit against Dr. Richardson, claiming he used excessive force and performed contraindicated therapy, resulting in a ruptured implant, need for surgery, and lost wages from inability to compete. Dr. Richardson’s defense team hired chiropractic and plastic surgery experts. The chiropractic expert found no deviation from standard care, stating that treating patients with implants is routine and not contraindicated.

The plastic surgery expert deemed it unlikely that chiropractic manipulation caused the rupture, suggesting it was more likely due to normal wear, the car accident, and Chase’s intense fitness routine. Chase’s experts argued that the adjustment violated the standard of care due to her implant history, and that the rupture was clearly caused by the chiropractic manipulation based on the timing of pain and the “pop” sound. Despite an initial $75,000 settlement demand, the case proceeded to trial due to minimal alleged damages and favorable expert reviews. Chase ultimately dropped the lawsuit. Key lessons from this case include:

• Timing of injury doesn’t automatically indicate negligence.
• Taking a complete patient history is crucial.
• Informed consent is essential, especially for patients with previous surgeries or health concerns.
• Standing firm on treatment decisions can be beneficial, as not all lawsuits end in settlements or payouts.

Item #2

Our second one today is called, “Recommendations for the management of hip and knee osteoarthritis: A systematic review of clinical practice guidelines” by Gibbs et. Al. and published in Osteoarthritis and Cartilage in October of 2023. Alison J. Gibbs, Bimbi Gray, Jason A. Wallis, Nicholas F. Taylor, Joanne L. Kemp, David J. Hunter, Christian J. Barton, Recommendations for the management of hip and knee osteoarthritis: A systematic review of clinical practice guidelines, Osteoarthritis and Cartilage, Volume 31, Issue 10, 2023, Pages 1280-1292, ISSN 1063-4584, https://doi.org/10.1016/j.joca.2023.05.015. (https://www.sciencedirect.com/science/article/pii/S1063458423008324)

Why They Did It

Guideline adherence for hip and knee osteoarthritis management is often poor, possibly related to the quality and/or inconsistent recommendations. This systematic review of hip and knee osteoarthritis guidelines aimed to appraise the quality and consistency in recommendations across higher-quality guidelines.

How They Did It

Guideline quality was appraised using the Appraisal of Guidelines for Research and Evaluation II (AGREE II tool) (six domains).

What They Found

• Seven higher-quality and 18 lesser-quality guidelines were included.
• Higher-quality guidelines consistently recommended in favor of education, exercise, and weight management and non-steroidal anti-inflammatory drugs (hip and knee), and intra-articular corticosteroid injections (knee).
• Higher quality guidelines consistently recommended against hyaluronic acid (hip) and stem cell (hip and knee) injections.
• Other pharmacological recommendations in higher-quality guidelines (e.g., paracetamol, intra-articular corticosteroid (hip), hyaluronic acid (knee)) and adjunctive treatments (e.g., acupuncture) were less consistent.
• Arthroscopy was consistently recommended against in higher-quality guidelines.
• No higher-quality guidelines considered arthroplasty.

Wrap It Up

• Higher-quality guidelines for hip and knee osteoarthritis consistently recommend clinicians implement exercise, education, and weight management, alongside consideration of Non-Steroidal Anti-Inflammatory Drugs and intra-articular corticosteroid injections (knee).
• Lack of consensus on some pharmacological options and adjunctive treatments creates challenges for guideline adherence. Future guidelines must prioritize providing implementation guidance, considering consistently low applicability scores.

Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.

Store Remember the evidence-informed brochures and posters at chiropracticforward.com.

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!

Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.

Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

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About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

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