CF 106: Joint Replacement Expectations, Spinal Infections, & Vitamin  D with Calcium

Today we’re going to talk about Joint Replacement Expectations how long can you expect a joint replacement to actually last, we’ll talk about Spinal Infections – what are some of the signs and symptoms according to research, and they we’ll cover a paper in JAMA on supplementation with Vit D alone vs. Vitamin D with Calcium. Stick around for a great show. 

But first, here’s that sweet like a Christmas candy cane bumper music

OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. So go get one and crack it open because we’re off and running. 

Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

If you haven’t yet I have a few things you should do. 

• Like our facebook page, 
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Do it do it do it. 

You have ping ponged into Episode #106. And my Parker alums will remember all of the ping pong that went on there at the student rec room. Pretty heated matches right there!

Now if you missed last week’s episode on Groupon deals, Gabapentin, and on Weight Loss…. make sure you don’t miss that info. As I tend to do, I got a little red in the face and probably got a bit dramatic and opinionated but I felt better by the time it was over with. 

Did you know that if you have an Alexa product, you can now just say something like, “Alexa, play The Chiropractic Forward Podcast on Apple Podcasts” and kablooey! You here the golden throated stylings of yours truly! Lol. You can say skip ahead 30 seconds, play previous episode, and on and on so pretty cool right there. 

On the personal end of things the Holidays are always stressful and this season has been a bit extra with my Dad having the stroke and being in the rehab hospital. That and whatever other daily trials and tribulations that come along with raising teenagers. 

It’s been journey but isn’t life just like that? Whack a mole every day. Whackin whacking whacking. Sometimes it’s exhausting. Obviously, I have a little turmoil poking it’s head up here and there lately but I’m a good swimmer. 

What I mean is, this world is full of sinkers and swimmers. Very rarely do you find simple water treaders. We’re sinking or we’re swimming. The sinkers let life happen to them rather than happening to life. 

They either make things happen, let things happen, or wonder what the hell just happen. 

On the other hand, swimmers are making things happen every day. Things keep coming at them and they keep batting them away and they stay above water. Hell, some of them make a game out of it and adapt to have the best breaststroke or back stroke you’ve ever seen. 

Those are the ones that just act like they’re indestructible. Well, I’m not indestructible. At all. I’ve been going through a season lately for sure. Nothing about business. All about my dad and other family stuff here and there. Luckily, I have an amazing wife and support structure. Good support allows swimmers to swim. She allows me to be a swimmer. No doubt. 

Enough about all that. Again, I share personal aspects because I know many of you will either relate on some level and ideally maybe even draw some inspiration. Others can learn from it I think. At least that’s my hope. 

By the time this airs, Christmas will have come and gone. I hope you had the merriest of Christmases. Being a Christian myself, I can’t tell you how much I love the season, the music, the magic of giving. Even with all of the hustle and bustle and pain in the butt it brings, it’s a special time of year and I try to keep it special for me and the family. 

Before we dive into the reason we’re here, it’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you don’t take advantage of this deal, I just think you might be crazy.

If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99.

Item #1

This one is called “Vitamin D and Calcium for the Prevention of Fracture. A Systematic Review and Meta-Analysis” it was authored by Yao, et. al. and published in JAMA Open on December 20, 2019(Yao P 2019). 

Hot hot hot like Texas in the Summer.

Why They Did It

Considering that vitamin D and calcium are recommended for prevention of fracture but prior RCTs have reported conflicting results, the authors wanted to assess the risks of fracture associated with differences in concentrations of 25-hydroxyvitamin D in observational studies and the risks of fracture associated with supplementation with Vitamin D alone or in combination with calcium in RCTs

How They Did It

• Systematic review and meta-analyses. 
• 34,243 participants. 
• They mined data from PubMed, EMBASE, Cochrane Library and other RCT databases
• Observational studies involving at least 200 fracture cases and RCTs enrolling at least 500 participants and reporting at least 10 incident fractures were included
• RCTs compared Vit D or Vit D with calcium with control
• Two researchers independently extracted the data and assessed possible bias

Wrap It Up

The authors concluded “In this systematic review and meta-analysis, neither intermittent nor daily dosing with standard doses of vitamin D ALONE was associated with reduced risk of fracture, BUT daily supplementation with both vitamin D and calcium was a more promising strategy.” To the tune of a 16% reduced risk of hip fracture. I’d sure as hell take that reduced risk if it’s my mom, wife, sister, or if it’s a patient. 

So, if you have a patient with osteoporosis and I know that you absolutely do…..it looks evidence-based to tell them to supplement with Vitamin D but only if they add Calcium to the mix. 

I love getting smarter and better. This is a nugget that does just that for us. 

Item #2

Joints!! 

How many knee replacements do you check reflexes on during the month? We average around 70-80 new patients per month so the answer in my office is, ‘several’. 

You probably already know that surgeons don’t like to do knee or hip replacements on younger folks because they don’t want the replacement to wear out before the patient dies. They don’t want the patient to have to go through the damn thing twice basically. 

The Lancet medical journal recently published two papers on the topic. One on the hip and one on the knee. One was called “How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up” and the other was called oddly enough “How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.” They were both authored by the same group led by Jonathan Evans and were published in The Lancet on February 16, 2019. Not hot off the press but not room temperature either. Very luke warm, folks. (Evans J 2019, Evans J 2019)

Why They Did It

For both papers, it’s pretty obvious why they did it. They want to know how long hips and knees last when replaced. Easy peesy. 

How They Did It

• The papers were systematic reviews and meta-analyses 
• Medline and Embase were used from Sept 12, 2017 to current
• They used 140 eligible articles
• They also reviewed reports of national joint replacement registries

Wrap It Up

On the hip paper, they concluded “Assuming that estimates from national registries are less likely to be biased, patients and surgeons can expect a hip replacement to last 25 years in around 58% of patients.”

On the knee paper, they concluded “Approximately 82% of total knee replacements last 25 years and 70% of unicondylar knee replacements last 25 years.”

Isn’t good to have a solid number you can confidently tell your patients when they’re thinking about making that appointment with the orthopedic surgeon?

Item #3

Our last paper this week is on spinal infection. It’s called “Red flags for the early detection of spinal infection in back pain patients” authored by Yusuf et. al. and published in BMC Musculoskeletal Disorders in December of 2019. (Yusuf M 2019)

Sizzlin’ hot like a Summer sidewalk come on.

Why They Did It

The aim was to conduct a systematic review specifically reporting on studies that evaluated the diagnostic accuracy of red flags for Spinal Infection in patients with low back pain.

How They Did It

• Again they mined the biggies like Medline, Cochrane, and EMBASE,  but also Pedro, Web of Science, OpenGrey, and Grey Literature Report
• 40 papers were accepted
• A total of 2224 cases of spinal infection were identified

What They Found

• Spinal pain and fever were the most common clinical features
• Diabetes and IV drug use were the most occurring determinants
• MRI was the most used imaging and 
• Staphylococcus aureus and mycobacterium tuberculosis were the most common microorganisms detected. 

Wrap It Up

The authors wrapped it up saying, “The current evidence surrounding red flags for spinal infection remains small, it was not possible to assess the diagnostic accuracy of red flags for spinal infection…..the most frequently reported clinical feature was the classic triad of spinal pain, fever and neurological dysfunction.”

Key Takeaways

Store

Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at [email protected] if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

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 instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show us that patients can get good to excellent results for headaches, neck pain, back pain, and joint pain just to name just a few.

It’s safe and cost-effective. It can decrease surgeries & disability and we normally do it through conservative, non-surgical means with minimal hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering 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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

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 – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

• Evans J, E. J., Walker R, Blom A, Whitehouse M, Sayers A, (2019). “How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.” The Lancet 393(10172): 647-654.
• Evans J, W. R., Evans J, Blom A, Sayers A, Whitehouse M, (2019). “How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.” The Lancet 393(10172): 655-663.
• Yao P, B. D., Mafham M, (2019). “Vitamin D and Calcium for the Prevention of Fracture. A Systematic Review and Meta-analysis.” JAMA Open 2(12).
• Yusuf M, F. L., Selfe J, (2019). “Red flags for the early detection of spinal infection in back pain patients.” BMC Musculoskelet Disord 20.

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