Health & Exercise Forum

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 (Synvisc^R)  injections. However, when conservative measures fail, surgical intervention,  such as a joint replacement, becomes the next option. A total joint  replacement uses a prosthesis (artificial part) 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 an active  lifestyle. The ability to return to golf is 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 the past thirty years, I have had the pleasure of rehabilitating  countless patients with hip and knee replacements. What was once considered  aggressive to return to activities such as golf, is now relatively common.  But, to do so safely, requires preparation, precaution and good judgment.  Dr. Larry Foster, also known as Dr. Divot, is an orthopedic surgeon  and avid golfer and 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 – but often recommend caution
• NO EVIDENCE of higher complication rates for golfers than non   golfers
• 3-4 MONTHS of healing and rehabilitation is recommended before   golfing – often 6 months depending on the individual case
• 75% of the surgeons recommended using a golf cart – especially   for 18 holes and in the first year after surgery
• 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

Sources: Rothman Institute, Philadelphia, PA

• REHAB, REHAB, REHAB – if you want to get the most out of your new hip or knee, there is   NO substitute for continuing an exercise program long after discharge   from a formal physical therapy program. Work on range of motion, flexibility,   and strength exercises with light to moderate weights. Balance exercises,   swing simulation and fitness walking are valuable.
• 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.   It promotes a smooth sweep through the ball with less stress through   your joints.
• WEAR SPIKELESS SHOES – new styles offer very comfortable   shoes with low profile spikes. 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 your 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 it adds additional   stress on the knee when walking. If possible, take a caddie or pull   cart.
• HAVE FUN! When you first get back to golfing with your new hip or   knee be mindful to have realistic expectations. Forget about the score,   be happy to be playing and have fun!

Visit your doctor regularly  and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum" in the Scranton Times-Tribune.

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 associate professor of clinical medicine at The Commonwealth  Medical College.