GETTING BACK ON THE FAIRWAY WITHOUT KNEE PAIN Rothman Institute is a proud partner of the Philadelphia Section PGA
O1 TABLE OF CONTENTS: Introduction to Knee Replacement Arthritis: The Enemy of an Avid Golfer It Starts with a Diagnosis Managing Knee Pain with Prevention & Non-Operative Strategies 07: 09: 11: 13: Knee Replacement Surgery: Knowing When it s Time Knee Replacement Surgery: Answering Your FAQs Book That Golf Getaway! Why Rothman Institute?
O2 Knee replacements have become an extremely successful and common orthopaedic procedure. While the surgery itself produces great results for patients, the quality of your care and the precision of the procedure truly depends on the surgeon.
O3 For decades, your knees served you well and you never even thought about how they worked or why they worked. You were just glad they did. Your daily activities were never impeded by pain or stiffness and your strong, healthy knees allowed you to move well, change direction quickly, and support your body s weight in the process. Most importantly, they allowed you to get out on the course and play the game you love. Now, thinking back on those days, you can hardly remember what it felt like to walk without pain. These days, every movement is a challenge, and the severity of the pain is making you wonder how much longer you ll be able to keep playing golf. If you face a similar situation, then you ve come to the right place! You need to know that you don t have to live with chronic knee pain. Managing arthritis and maintaining an active, healthy life starts with being informed. In this ebook, you ll find: general facts on joint health tips on preventing knee arthritis non-operative treatment options information on knee replacement surgery specific tips for golfers on knee replacement recovery
O4 ARTHRITIS: THE ENEMY OF AN AVID GOLFER Where the femur and tibia meet, cartilage protects the knee joint, allowing it to function without the pain of bone-on-bone interaction. When the knee is healthy and the cartilage is intact, the joint functions as it should, allowing you to run, walk, squat and change direction as your knees properly support the weight of your body and facilitate your movement. Because the body is only given one set of natural cartilage, when it wears down, bones are exposed within the joint, making every movement extremely painful. This condition is called osteoarthritis (and is also frequently referred to as wear and tear arthritis). When it sets in, the knee joint can become inflamed and basic movements can become difficult to perform without pain, swelling and stiffness. Approximately one in every five people in the U.S. will suffer from knee arthritis at some point during their lifetime. If you are one of these individuals, then you may have found that over the years, knee arthritis has significantly impacted your ability to live a healthy, active lifestyle. When pain takes away the joy of something you love - like playing golf - it compromises the quality of your life. Causes of Osteoarthritis: The trauma of an injury, especially if it does not heal properly Most commonly, degenerative joint disease; secondly, inflammatory conditions like Rheumatoid arthritis Genetic makeup, which determines the durability (or lack thereof) of a person s cartilage
O5 IT STARTS WITH A DIAGNOSIS When you make your first appointment to see a physician about your knee pain, here s what to expect... Generally, physicians are able to diagnose arthritis after a physical exam and by reviewing x-rays; sometimes, a CT scan or MRI is ordered. In the case of osteoarthritis, the inflammation is caused by bone-on-bone interaction in the joint, so an x-ray alone will usually indicate that very clearly, as it will show no space between the tibia and the femur. Common Mistakes Golfers Make & How to Avoid Them: Common mistake: Golfers who don t warm up or stretch before their game could risk knee health or aggravate existing injuries such as: chondrosis, meniscus tear, osteoarthritis, a torn anterior cruciate ligament, or a torn medial collateral ligament. Common mistake: Golfers injure their medial meniscus when they shift their weight forward on their lead foot on the swing through making a squared and internally rotated and locked motion in the knee. Common mistake: Golfers who took a break from the sport and don t consider that activity as simple as walking the course and repeatedly picking up every ball will leave them vulnerable to injury. Common mistake: Golfers who hit longer distance shots with significant knee rotation and force may not initially respond and treat the stress and pain in their knee. Common mistake: Golfers who assume their knees, hips, and back are flexible by default miss out on a stronger flexed backswing and increase their susceptibility to injury. Avoid this mistake by stretching the hamstring, hip flexor, and thighs to warm-up. Avoid this mistake by rotating your left foot 20-30 degrees toward the target, notably shifting instead of sliding your hips, and during the downswing shifting the lead knee in front of the hip as early as possible. Avoid this mistake by easing back into longer games, utilizing a cart and increasing the holes walked by two holes per round, and letting a ball retriever support your efforts. Avoid this mistake when in pain by focusing more on shorter distance shots using short irons and pitching wedges. Avoid this mistake by fully rotating the hips, knees and back with loose knees on the backswing and by using weight conditioning to strengthen the muscles in the back, and around the knee and hips with a physical therapist or trainer.
O6 MANAGING KNEE PAIN WITH PREVENTION & NON-OPERATIVE STRATEGIES Although there is no cure for arthritis, there are many treatment options available to help you manage pain, prevent further degeneration and maintain a healthy, active lifestyle. Ask your physician about which of the following treatment options would work best for your particular case of knee arthritis: Lifestyle Modifications: such as losing weight or adjusting daily activities Exercise: strengthens surrounding leg muscle to help absorb the impact of movement Stretch & Always Warm Up: helps your knees maintain maximum flexibility Know Your Limits: pushing through pain could be making your arthritis worse Medications: such as anti-inflammatories and cortisone injections Physical Therapy: could be beneficial for restrengthening the knee in some patients Supportive Devices: these transfer impact to a part of the knee that is less arthritic A combination of these non-operative measures may help ease the pain and disability caused by knee arthritis.
O7 KNEE REPLACEMENT SURGERY: KNOWING WHEN IT S TIME If non-operative treatment approaches have failed to make your knee pain bearable, surgery may be the best option to get you back out on the fairway. Potential candidates for knee replacement surgery are patients who after exhausting non-operative treatments are still suffering from significant pain and limited mobility due to osteoarthritis. If the simplest of daily tasks has become extremely difficult, it s time to take action. When you re turning down tee times because the pain is too severe, it s time to talk to your physician about the possibility of knee replacement surgery. Of course, pain is measured subjectively, which is why the decision to move forward with surgery should really be between you and your doctor. They will be able to make a recommendation for you based upon your age, anatomy, and the severity of your arthritis.
O8 Why Joint Replacement Surgery? The fact of the matter is that you only have one coating of cartilage to last you your entire lifetime. If that cartilage is significantly damaged, you re left with chronic pain. No one wants to live with a painful, unstable arthritic knee, especially when the weather gets nice and the greens are calling. For patients with this severe level of knee arthritis, a knee replacement procedure can dramatically increase their quality of life. And isn t that what it s all about? After all, the goal of a knee replacement procedure is to: reduce pain improve mobility return the patient to an active lifestyle as soon as possible COMMON More than 600,000 knee replacements are performed each year in the United States. EFFECTIVE 9 out of 10 patients who undergo the procedure report improved pain relief and knee function. SAFE Serious complications, such as a knee joint infection, occur in fewer than 2% of patients. CUSTOMIZABLE Various size implants can be used to give each patient the perfect fit for their new knees. DURABLE More than 95% of modern total knee replacements are still functioning well 15 years after the surgery.
O9 KNEE REPLACEMENT SURGERY: ANSWERING YOUR FAQS Will my new knee joint last for the rest of my life? For many patients, knee replacements do serve as a lifelong solution! If you re looking for numbers, here s what we can tell you: you can expect a 98% chance of success at 10 years and after 20 years, there s still a 94% chance that your replacement joint will be functioning well. You can help keep your knees healthy by maintaining your weight at a doctor recommended level, exercising regularly and protecting against infection. 95% CHANCE OF SUCCESS AFTER 15 YEARS! What are the potential complications of this surgery? Inflammation of the leg veins is occasionally a concern, but the dangers associated with that complication have been significantly decreased through the use of support stockings and blood thinning medications. Infection is also a risk. However, joint replacement procedures at Rothman Institute are conducted in the most sterile environment possible, and our surgeons wear full body suits to further prevent the possibility of infection, which is less than 2%. Will I be able to get back to the activities I love? We know you love to golf and that you re already wondering when you ll be able to return to playing once your surgery and recovery is complete. The answer to that question really depends on your preoperative range-of-motion. If you are still able to bend and extend your knee with a decent range of motion prior to surgery, then there is no reason why (with proper physical therapy during your recovery), you shouldn t be able to return to the tee box and most of the other activities you enjoy.
10 A successful surgery will usually result in a standard recovery period: Day(s) After Surgery: Most patients can stand and begin basic movement soon after surgery! After one or two nights in the hospital, you ll be ready to head home. 2 Weeks Post-Op: If staples were used, those will be removed at a post-op visit. After two weeks, you may be able to begin driving again. 4-6 Weeks Post-Op: Another visit will be scheduled with your surgeon to check the incision site and progress of your recovery. 6 Months Post-Op: During this time, your knee will be gaining strength and range of motion. Swelling is normal for many months after surgery, but regular icing can keep it to a minimum. As you progress through physical therapy and your physician follows up with you, you ll talk about when is a good time to get back to more physically demanding activities, like golf! This decision is made on a case by case basis. Your surgeon will advise you based on how your incision is healing and if your mobility and range of motion is improving. I was so reassured...i cannot tell you how amazing this guy was. Today, the pain is gone. I am so grateful for what was able to be done for me. Rothman was terrific and my knees are proof. If I had more knees, I would do them tomorrow. - Jerry, Patient Ambassador
11 What can I do to make my recovery easier and faster? At Home: Make plans to set up a bedroom that has easy access to a bathroom and to the kitchen, which will make navigating around much easier during that first week or so after surgery while you are still getting comfortable with walking with a cane. Stay Healthy: Maintaining a healthy weight will play a big role in protecting your new joint and allowing your body to recover well. Extra weight puts unnecessary pressure on your knees. If you smoke, you should also talk to your doctor about a plan for quitting prior to surgery. Plan for Rides: You ll be able to get into and out of a car almost right away, but you should not drive for at least two weeks after surgery. Make plans to have rides available for anywhere you need to go. Follow Instructions: Following your orthopaedic surgeon's instructions after surgery and taking care to protect your knee replacement and your general health are all important ways you can contribute to the final success of your surgery and promote a faster recovery. BOOK THAT GOLF GETAWAY! If you enjoy golfing, you ll be glad to know that your new knee will hold up just fine out on the course! In fact, if having a golf getaway on the calendar will keep you committed to physical therapy, then we say, book it!
12 Here are a few additional tips we often give to our golfer: Start slowly with chipping and putting before progressing to playing 9 or 18 holes. While walking for exercise is important for your heart, resume your golfing career by using a cart. Eventually you can walk the course. At that time, use a caddy or a roller for your bag. Carrying your bag increases force across your knee joint and may excessively stress your new knee. Avoid playing in wet weather where the chance of slipping or falling during a golf swing is increased. Learn to play more "on the toes". Swinging flat-footed increases stress on the joint replacement. On the backswing, the left heel should come off the ground and on the downswing, the right heel should come off the ground. (Note: This recommendation is for right-handed golfers and the terms "right/left" need to be reversed for left-handed golfers.) Right-handed golfers with a right total knee replacement may benefit from "stepping through" their swing with their right leg. The right leg comes off the ground during the downswing and follow-through, and actually steps toward the target. This will effectively unload a right total knee replacement; however, no golfer with a left total knee replacement should attempt this, as it may result in excessive loading of the left knee. Right-handed golfers with a left total knee replacement may benefit from an open stance. This may make the backswing a little more difficult, but if the player allows his left heel to come up, he should still be able to accomplish a full turn. The open stance has the golfer facing the target, and the hips do not need to turn as drastically to the left in the impact zone, thereby reducing the stress and torque within the left knee.
13 WHY ROTHMAN INSTITUTE? Knee replacements have become an extremely successful and common orthopaedic procedure. While the surgery itself produces great results for patients, the quality of your care and the precision of the procedure truly depend on the surgeon. At Rothman Institute, we focus on getting patients back to an active lifestyle as quickly as possible. Along the way, we make use of the most cutting edge technology, material and surgical methods. We are one of America s top joint replacement programs, and with over 10,000 such procedures performed annually, we are proud to offer the clinical expertise you need for your knee replacement surgery. To find the top doctors in the orthopaedic field - and specifically in knee replacement - call Rothman Institute. You ll benefit from the backing of an entire team of knee experts and a unique, comprehensive approach to care. We can t wait to help you get back on the course and finally be able to play again. 1-800-321-9999 925 Chestnut Street, 5th Floor Philadelphia, PA 19107 SOURCES http://orthoinfo.aaos.org/topic.cfm?topic=a00389 https://www.rothmaninstitute.com/specialties/treatments/total-knee-replacement http://www.rothmaninstitute.com/specialties/conditions/knee-arthritis http://www.hss.edu/conditions_arthritis-of-the-knee-total-knee-replacement.asp#.vvkgu84zfww http://www.arthritis.org/about-arthritis/where-it-hurts/knee-pain/knee-care/prevent-knee-problems.php