Golfers and the Total Joint Replacement

Here are some general guidelines for returning to the links after joint replacement surgery.

By Jeff Banaszak - Posted May 15, 2006

The total joint replacement is an operation often encountered by senior golfers.  A painful osteoarthritic hip, knee or shoulder can often prevent a golfer from the enjoyment of leisure activities such as golf.  The joint replacement is one option, which can potentially help the individual return to this activity without pain.

Back in 1999, Jack Nicklaus, winner of 18-major golf championships and considered by many the games greatest golfer, brought the total joint surgery into the spotlight.  A long history of severe osteoarthritis made it difficult for Jack to finish his golf swing, walk on uneven surfaces or even get out of a chair.  After years of conservative management, including physical therapy, Jack elected to have his left hip replaced.  On January 27th 1999, Benjamin Bierbaum, MD of the New England Baptist Hospital in Boston, MA installed a new ceramic joint attached to a titanium shaft (i.e. another example of how technology is affecting the game of golf!).  After successful rehabilitation, Jack has returned to competitive golf.

What about the rest of us who may not be professional golfers?  Is there hope for a full return to game after total joint surgery?  The answer is most definitely YES, just remember that not everyone is a professional athlete and that it is critical to follow the specific guidelines set-up by each surgeon.  This will assure a safe and quick return to the course.

From my experience as a physical therapist, I see most golf athletes returning to their sport relatively quickly avoiding any complications.  Finding a licensed healthcare professional that has experience working with joint replacements can help accelerate the return.

Here are some general guidelines for returning to the links after joint replacement surgery (REMEMBER: These are only suggestions, it is critical to follow the guidelines outlined by each surgeon):

Total Hip Replacement

Most patients return to playing golf within 3 to 4 months after surgery with no specific limitations.  It is essential for each golfer to maximize strength and range-of-motion throughout the lower extremities.  Some technique changes can decrease stress to the involved limb such as rotating the surgical side foot slightly outward at address.  This can reduce stress at the hip while maximizing the individual’s ability to turn.  Each golfer must practice their post-surgical hip precautions during the round that include the avoidance of excessive hip ADDuction (i.e. bringing the leg towards midline of the body) past mid-line, hip internal (i.e. inward) rotation and hip flexion (i.e. forward bend) greater than 90°.  It is also important to maximize the golfers’ ability to rotate through their trunk as a way to reduce stress to the tissues surrounding the hip.

Total Knee Replacement

These individuals must control and minimize the amount of torsion or rotational stress at the knee following surgery.  Strengthening the musculature of the lower extremities will help with active support.  The technique changes that decrease the amount rotational stress at the knee are very similar to the previous suggestions for the hip replacement individual.  These include rotating the foot outward, pushing the big toe downward and opening the address stance.  The golfer may want to avoid extending or locking of the knee during the backswing on the trail side.  Maintaining a flexed position at the knee throughout the swing will assure that the muscles surrounding the knee remain activate therefore helping to maximum the joint protection.  Additional benefits may be seen from a golf-specific stretching program that targets the key muscles throughout the hips and upper body therefore reducing stress during the turn.

Total Shoulder Replacement

The shoulder is the most challenging replacement surgery and it is extremely important to follow the guidelines of your physician.   A return to the links will take at least 12-weeks and requires full pre-operative range-of-motion to be regained.  The golfer should concentrate on chipping and putting only advancing to longer shots if they remain symptom free.  Play “winter rules” to avoid shock transmission at impact.  These golfers’ may want to tee up all shots even in the fairway.  Take a special look at your equipment choices following this surgery.  Graphite shafts can reduce shock and the replacement your longer irons with fairway woods which require more of a sweeping motion will help.

The following are some general guidelines for golfers with joint replacements:

1. Avoid playing in wet weather to avoid slips or falls during the swing.

2. Use soft spikes versus metal to help avoid stress to the joint while still maintaining good traction to avoid falls.

3. Use a golf cart especially when first returning to play.  This will limit the effects of prolonged weight bearing and walking on the joint.

4. Play more on the balls of your feet during the swing.  Swinging the club flat-footed increases the rotational stress on the joint replacement.

5. Begin your return slowly following the guidelines of your physician.  Initially concentrate on chipping and putting gradually lengthening the swing.

6. Remember each person recovers differently with his or her own rate of healing.  Do not compare your recovery pace to others.  Use your symptoms and physician recommendations to return to play.

7. Find a qualified golf fitness and/or medical professional.  Their guidance and expertise can help improve your conditioning and fitness levels.

Reference Section

1. Archambault ML, Ferrante HJ, Nix T:  BACKtoGOLF: A Sports Medicine Program for Golfers.  Course Manual, 1998.

2. Mallon, WJ, Liebelt, RA, Mason, JB:  Total Joint Replacements and Golf.  Clinics in Sports Medicine 15 (1), 179-189, January 1996.