Golf and the Total Joint Replacement By By Jim Gorman, LPTA GOLFViews Contributing Writer The game of golf continues to grow in worldwide popularity now making it the number one played sport across the globe. There are at least 14,648 golf courses in the U.S. alone with an expansion rate in the 1990's that doubles that of the 1980's.1 Statistics show that the average age of the golfing population is from the early 50's through the late 60's. Statistics also show that it is during these years that many people elect to undergo total joint replacement. According to the American Academy of Orthopedic Surgeons, it is projected that during the year 2000 163,000 individuals between the ages of 45 and 74 will have total joint replacement. Based upon this information, it is highly likely that many of these patients play golf and will need some guidance as to when they can resume playing. Because golf is considered a game for a lifetime, people often continue to play into their senior years. Unfortunately, the human body ages and the joints are often affected by osteoarthritis or degenerative joint disease. With this in mind, let us examine golf as it affects the total hip patient. According to the Hip and Knee Society, it is felt that playing golf is not a contraindication to total hip arthroplasty.2 It is also noted that members of the society have not seen an increase in complications or revision rates in their golfing populations as compared to their non-golfing populations.2 While the total hip prosthesis is not affected by the golf swing, it is suggested that the player make a few adjustments in several areas. First a more classical swing may need to be implemented.3 This type of swing emphasizes greater hip turn in unison with the shoulders as opposed to the modern swing which emphasizes a large shoulder turn with little hip turn. The modern swing tends to place excessive torque on the hip joints and should try to be avoided. Second, the total hip golfer should learn to play more on the balls of their feet in order to avoid swinging flat footed.2 This move is done to minimize the torsional stress loads that occur on the hip joints during the swing when the feet are firmly fixed to the ground.2 The lower back and trunk muscles should also be utilized to produce the turn so that less stress will be placed on the hip musculature. As for having to utilize a golf cart, more than one-half the members of the Hips and Knee Society recommend the use of a cart when playing.2 As far as loss of distance of shots, the total hip golfer should not have a problem whereas the total knee golfer is not so lucky.3 Return to play for the total hip player should begin slowly with chipping and putting. Gradual lengthening of the swing should be encouraged with eventual return to the full swing after about three to four months.2 At this point it should be safe to return to play but please consult your surgeon since there is yet to be a fully researched and proven protocol. The return to play protocol for the total knee patient is similar to that of the total hip player. Dr. James Andrews reports that the total knee patient should being to chip and putt at four to six weeks from surgery, with half to three quarter swings beginning about two weeks thereafter. Full swings and a safe return to play will be in three to four months post-op. Dr. Andrews as well as most members of the Hip and Knee Society feel that total knee replacement is not a contraindication to playing golf.2 During or after play, patients with total knee arthroplasty will normally have more post-round pain than those who have had total hip arthroplasty.3 This pain is not severe and is usually described as a mild ache.4 Even though the total knee prosthesis is not mechanically affected by the golf swing it may be necessary for the total knee player to make some equipment adjustments such as wearing spikeless shoes.1 This is done so that the feet are not fixed to the ground. If the feet are firmly fixed greater force can be generated through an increase in torque. With more people taking up the game of golf each day coupled with aging America and the advancements in orthopedic medicine, there will soon exist a great number of players who have had total joint replacement. These players can have peace of mind in knowing that neither pain nor prosthetic wear and tear will limit playing time. In fact, in a few short months after their surgery, and with a few minor adjustments in swing mechanics and equipment, they can be back on the course as testimony that golf is truly a game for a lifetime. By Jim Gorman, LPTA, one of the golf performance specialists nationwide for HEALTHSOUTH, the official sports medicine provider for the PGA, LPGA and Senior Golf Tours. For more information or to schedule an appointment with a HEALTHSOUTH physical therapist/golf performance specialist, please contact Luke Menke at 720-922-7553 or Brad Cooper at 303-789-0772. REFERENCES 1. Guten GN: Knee injuries in golf. Clinics In Sports Medicine 15:111-129, 1996 2. Mallon WJ, Liebelt RA, Bohannon MJ: Total joint replacement in active golfers. Clinics in Sports Medicine 15:179-189, 1996 3. Mallon WJ, Callaghan JJ: Total joint replacement in active golfers. Journal of Southern Orthopedic Association 3:295-298, 1994 Mallon WJ, Callaghan J: Total knee arthroplasty in active golfers. Journal of Arthroplasty 8:229-305, 1993