Health & Exercise Forum

Golf with Hip and Knee Replacements: Part I of II

Osteoarthritis slowly develops in the weight-bearing joints, most commonly in the hip and knee, creating pain, stiffness, swelling and loss of function. There are many nonsurgical options such as: rest, weight loss, medication, physical therapy, steroid injections, and viscosupplementation injections. However, when conservative measures fail, surgical intervention, such as a joint replacement, becomes the next option. A total joint replacement uses a prosthesis to replace the end of the bone damaged from arthritis. These new metal and plastic surfaces in the joint allow the painfree movement and function in the hip and knee. These procedures have been performed since the early 1970’s. The outcomes for active people continue to improve with advances in technology, prosthetic materials and new techniques. As a result, many active people are eager to use there new joint to continue their active lifestyle. The ability to remain active while not compromising the integrity of the new joint continues to be the source of some controversy. It will be the purpose of this column to review the literature and make recommendations to safely return to golf with a hip and knee replacement.

Over twenty years ago I worked with Paul Remick, and avid golfer who had knee replacements to both knees. After months of extensive therapy he was ready to play golf. However, he was very apprehensive. He decided to insure his safety by inviting the two surgeons who operated on his knees (Dr. Eugene Chiavacci and Dr. Carl Steindel) and me, his physical therapist, to a round of golf at the Country Club of Scranton. I am happy to say that he played well and his knees held up to the task! Since that time many people ask me to discuss playing golf with total joint replacements. Interestingly enough, I discovered Dr. Larry Foster, also known as Dr. Divot, an orthopedic surgeon and avid golfer who is the author of “Dr. Divot’s Guide to Golf Injuries – A Handbook for Golf Injury Prevention and Treatment.” Dr. Divot, who lectures to PGA and LPGA golf professionals, medical doctors and physical therapists across the country, has reviewed the medical literature to determine the safety of golfing with hip or knee joint replacements. This research, as well as surveys from the Hip and Knee Societies of the American Academy of Orthopedic Surgeons, has concluded some interesting and encouraging findings for golfers with hip or knee replacements:

• Surgeons typically DO NOT PROHIBIT golfing
• NO EVIDENCE of higher complication rates for golfers than non golfers
• 3-4 MONTHS of healing and rehabilitation was recommended before golfing
• 75% of the surgeons recommended using a golf cart
• Professional golfers and instructors were able to continue unhindered
• 90% of amateurs were able to play without pain
• 10% of the amateurs with pain reported less pain golfing than before the surgery

Tips for Golfers with Hip or Knee Joint Replacements

Contributions: Eugene Chiavacci, MD, Rothman Institute, Philadelphia, PA

• Start Slowly – begin with chipping and putting. Then, work on the practice range. Gradually, play 2-3 holes, then 6-7, then 9, then 18 over a few weeks.
• Play with Tees – tee the ball up even in the fairway the first few times you play.
• Wear Spikeless Shoes – which is required at almost all courses. This limits torsion on the hip and knee joint.
• Fair Weather Play – don’t play on a wet and slippery course. Use caution on walking up and down elevated greens and tees – use the stairs.
• Play on Your Toes – not flat footed. To limit torsion on the hip/knee, lift the left heel up on the backswing and the right heel up on the follow through. (for a right handed golfer)
• Open Stance – at address turn you left foot out to 10:00 to limit torsion on the hip/knee.
• Use a Cart – especially for the first few months back into the game. Eventually, walking may be performed in dry conditions. Begin by walking a few holes and work up to 9 holes. Only progress to 18 holes if comfortable with 9 holes.
• Do Not Carry Your Bag – if you walk don’t carry your bag because the bag adds additional stress on the knee when walking.

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”   GOLFING WITH HIP & KNEE REPLACEMENT – PART II

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliated faculty member at the University of  Scranton, PT Dept.