If you are an avid golfer who is having a knee replacement, you should use precautions when returning to your sport. While most surgeons will not tell you to avoid golf, it can place extra stress on your new knee. Being diligent in your rehabilitation and making some modifications may help reduce the risks.﻿﻿

Making Knee Replacements Last

Both patients and doctors are interested in doing whatever they can to help ensure a knee replacement will last as long as possible. Improving implant design, ensuring replacements are properly inserted and aligned, and counseling patients on behaviors can all help to make replacements last as long as possible.

There are activities that place more forces and stress on knee replacements, and because of this, surgeons will often ask patients to avoid impact sports activities such as running and jumping. However, there is not a lot of data to guide recommendations on which activities are best to avoid.

How Much Stress on Implants?

A 2008 study quantified which activities cause the most stress on knee replacement implants.﻿﻿ A handful of patients who required total knee replacement because of severe knee arthritis were outfitted with special knee replacement implants. Embedded inside these implants were pressure sensors that could provide accurate information about when the implants experienced unusual forces and pressure.

The study found, as suspected, that low-impact activities such as stationary bicycling placed very little stress on the knee replacement implants. On the other hand, activities such as running and tennis placed predictably higher stress on the implants. However, there were some surprises—golf placed some of the highest stress on knee replacement implants. Specifically, torsional forces on the leading knee of the golf swing were some of the highest forces tested.

Golf or No Golf?

So the question comes up: should doctors advise their knee replacement patients to avoid golfing? You will have to discuss with your surgeon their specific recommendations as most surgeons don't advise patients to avoid golf.﻿﻿

There is limited information about which activities really place the most stress on implants, but the 2008 study indicated that golf could be an activity that leads to more rapid wearing away of the implanted joint. That said, this was a very small study, that looked at one specific knee replacement implant. A 2017 review of studies concluded that golfers undergoing total hip, knee, or shoulder arthroplasty could safely return to sport.﻿﻿

Knee replacement implant improvements may help address these concerns, and some particular types of implants may help patients who want to participate in activities that place particular stresses on the knee joint.

There are benefits of golf of getting exercise, keeping weight down, and improving emotional health.﻿﻿ It may be (and often is) worth the possible risk of implant longevity for knee replacement patients to participate in these activities that bring them fitness and joy.

The flip side of this argument is that stress on implants can also be increased by weight gain. Golf is an activity that keeps people exercising. Getting outside, walking, and moving around are all good for knee replacement patients. If a little golf is what keeps people moving, then perhaps the stress on the implant is worthwhile.

Precautions for Returning to Golf

Discuss your return to golf with your doctor and physical therapist. You will likely be advised on how long it should be before you can head to the links. Three months of rehabilitation and strengthening are needed to restore your knee to the strength of the non-operative side. It's likely you won't released to return to golf until 18 weeks after your surgery.

A specific recommendation is to protect the knee during your golf swing.﻿﻿ If your lead knee had the replacement (the left knee if you golf right-handed) it will sustain a rotational force during the golf swing. At first, you may want to make only short shots or perform half or three-quarters swings. You can reduce the torsion by not wearing spikes, or wearing only soft spikes.

Limit the number of holes you play at first. As always, pain should be your cue that your knee has had enough for the day.