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Golf After Total Joint Replacement
As a Physical Therapist, I see many patients who have a desire to return to golf after a Total Hip Replacement or Total Knee Replacement. In fact, many of the these patients have the Joint Replacement surgery to extend their ability to play. Many of them are avid golfers and have found increased difficulty with walking a course, driving the ball, or even just playing 18 holes and have had to limit their play time. Most, if not all, of these patients can return to playing golf.
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. After successful rehabilitation, Jack returned to competitive golf.
Below, I have outlined a general description of the rehab/recovery process after joint replacement from a physical therapy perspective.
Post Operative Phase (Day 0 to 48/72 hours after surgery): Typically this phase is focused on pain control and early mobility: Physical Therapy will begin in the hospital post op day 1 to help get you up and moving, and used to putting weight onto that leg in conjunction with any weight bearing or Range of Motion precautions the surgeon may give you. Typically you use a front wheeled walker or crutches initially with ambulation. After Total Knee Replacement the surgeon may give you a CPM (Continuous Passive Motion) machine that may help with initial pain control and early Range of motion. For a Total Hip Replacement, the surgeon may likely give you range of motion precautions including no hip flexion past 90 degrees, no hip adduction (or crossing your legs), and no internal hip rotation (turning your foot inward)
Early Recovery (Acute Phase) Day 3 to 10: If you are doing well in the hospital you will be discharged home day 2-3. If you need continued daily care and need a little more therapy prior to returning home, then you may be discharged from an Acute hospital to an inpatient rehab facility for typically up to 10 days or sooner. Once you return home you will likely receive home services for continued care but will need additional help at home. This phase is extremely important to begin isometric strengthening exercises for the hip and knee joint balanced with pain and swelling control. You will begin gentle range of motion exercises and continued use of pain medications along with ice and elevation. You will continue to use the walker/crutches and possibly progress to a single point cane as early as 2 weeks after surgery if doing well and have no limitations (walking without a limp using the walker) from your physician.
Mid Recovery (Sub-Acute Phase) Week 2-4: During this phase, inflammation has lessened and you will be able to tolerate more activity due to decreased pain and swelling reduction. Staples are typically removed around the 2 week mark following your surgery. During this phase you will focus on progressing your range of motion and strengthening the knee to work on regaining "normal" range of motion. The goal of in home therapy is to get at least to 90 degrees bending of the knee prior to beginning outpatient rehab. The goal after a total hip replacement is to restore strength around the hip and walk without limping. Initially exercises are performed at least 2x/daily and it is advised you continue to take your pain medication during this phase. Once you are moving around the house well and able to get in/out of the house more easily, you will be discharged from home services and progressed to outpatient rehab around the 3rd to 4th week. It is typically advised to avoid prolonged weightbearing periods onto the involved limb for the first few weeks following surgery, (ie shopping). You may still be walking with a walker/crutches or a cane at this point. Your therapist will progress your assistive device based on your pain, strength, and tolerance to activity. During this phase it is important to resume independence with daily tasks such as showering, dressing, household activities, meal prep, etc.
Late Recovery Week 4-12:During this phase, you will begin outpatient physical therapy for continued strengthening, range of motion progression, and return to activity. During this phase you will likely progress from walker to cane to no assistive device based on your strength return. Typically it takes 4-6 weeks to see improvements in strength following surgery. Your compliance to therapy in the first several weeks after surgery is crucial to your long term recovery. It is important that you perform the exercises within a relatively pain free range in the early phases since pain can cause inflammation, swelling and thus, set-backs. Around 6 weeks post-operative you will likely be able to drive as long as you can demonstrate good strength and are no longer taking pain medication. Continue to work on your home exercise program. Be sure to let your therapist know your goal of returning to golf so he/she can plan you treatment accordingly to meet you needs
Returning to golf can take anywhere from 3-6 months after surgery and may initially need to be modified with minor technique changes to minimize increased strain or torque onto the prosthesis until you can build your bodies strength and endurance back up to playing 9 to 18 holes. In order to return to effective play it is important to focus on key components of the rehab process. Physical therapy is a vital component of the rehab process and requires full participation by the patient for optimal outcomes. It is likely that once returning to golf, you may initially experience some soreness to surrounding muscles of the knee and hip. Patients who have a total knee replacement may be more likely to have post round soreness than patients with a total hip replacement.
Strive to Thrive
Megan Cesario, PT
Licensed Physical Therapist
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