Getting back on the golf course after knee replacement
Getting back into the swing of things can be a smooth process for golfers who’ve had knee replacement, according to a local orthopedic surgeon.
“There’s a very high satisfaction rate with golfers after this surgery,” said Andrew Markwith, MD, an orthopedic surgeon who specializes in sports medicine at Falmouth Orthopedic Center and performs surgery at Falmouth Hospital.
“More and more, this surgery is an outpatient procedure, so the recovery starts the same day as surgery or the day after surgery, with physical therapy and a visiting nurse coming to the patient’s house. Within a few weeks, they transition to an outpatient physical therapy facility. There’s a period of using crutches or a walker for the first few weeks, but patients are allowed to put all their weight on it right away, and then many times after a month, patients can progress to a cane.”
Patients can see variable results, but most can ease their way back into golfing after about six weeks.
“Patients can start by putting and chipping to get their feet wet. I always tell my patients the scoring in golf comes from the short game, so that works out well. It helps their morale just to be out there putting and chipping,” Dr. Markwith said.
A Slow, Steady Progression
After two weeks of that, it’s a slow, steady progression. The next step is going to the driving range, starting with wedges and shorter distance clubs, and using half swings or three-quarter swings for two weeks.
“Now it’s around the two-month mark, and if that goes well, you can progress to full swings on the driving range,” he said. “By three months, you can get out on the golf course and start to play. We often recommend going with a golf cart instead of walking, and starting with nine holes. Some patients’ knees will tolerate that, and others won’t, and that’s okay. It’s important to be willing to pack it in after five holes if the knee just isn’t quite ready and not to get too discouraged with that.”
The signs indicating that it's time to back off are increasing pain, increasing swelling of the knee and loss of range of motion, he said.
“Those would be the main things to look out for, but typically by three months, there’s enough healing that there would be a very low risk to reinjure the knee. It’d be more that the knee can become very inflamed if they push through it too quickly. For a lot of patients, before they’re playing 18 holes comfortably, it can take six months.”
Golfers typically face no restrictions post-knee replacement, Dr. Markwith said, unless they required a more complex type of surgery, such as a redo replacement. In that case, they may need to always use a cart or go with a half or three-quarter swing. “That’s definitely the exception,” he said.
Get a Golf Lesson or Two
He recommends getting a lesson if it is difficult getting back to where you thought you would be.
“Sometimes you could subconsciously be making some adaptations in your stance or swing,” he said. “It’s never wrong to go get a golf lesson to try to identify any simple abnormal swing patterns.”
Post-surgical patients could also consider enrolling in the Cape Cod Healthcare Golf Performance Program in which a Titleist Performance Institute physical therapist performs specific golf movement tests to identify your levels of strength, flexibility, balance and coordination. These results help establish a customized Golf Performance Fitness Program, identifying which golf-specific exercises will maximize your swing’s potential and improve your durability.
Most knee replacements are necessitated by arthritis, which results in chronic wear and tear on the knee, Dr. Markwith said.
“It would be extremely unlikely that you would ever need a knee replacement because of a golf injury,” he said.
For some golfers, deciding on what time of year to have the surgery is important.
“There’s never a convenient time of year to do it, so I ask my patients (to tell me) when would be the least inconvenient time,” Dr. Markwith said. “Maybe there’s a three month stretch out of the year that you’re willing to sacrifice for the recovery.”
Surgery is not necessarily the first option Dr. Markwith recommends for knee problems.
“I see a lot of patients, maybe they’re going to go on a golf vacation or starting the golf season. They start exercising more, and the knee gets sore. We try to promote conservative treatment prior to jumping to surgery. At our office, we do a lot of the standard cortisone injections, which work quickly and usually works for about three months. We also offer hyaluronic acid injections. One of the newer treatment options is a long-acting steroid. We have to get a special approval for insurance, but that’s another good option to try to put off surgery. If those things aren’t working, we move forward with knee replacement with one of our total joint replacement specialists.”
