Text: R. Collins

Beginning with bent knees, the anatomy of a golf swing involves working several joint groupings on the body, from wrists and elbows to hips and ankles. The twist of the upper body grinds back down onto the pillar of the lower, and it ends as swiftly as it began. One thing that is as familiar for some golfers as a graceful swing is the eventual joint issues that it can also create, not to mention the task of walking a hilly course. Many golfers can eventually experience arthritis or joint discomfort and even severe pain, but with the marvels of modern surgery and medicine, some work can be done to mitigate these issues or make them disappear. 

For this issue of The Golf Explorer: Michigan’s Journal to Incredible Golf, we spoke with Dr. Kevin Howard, DO, orthopedic surgeon at the University of Michigan Metro Health campuses in Rockford and Wyoming, Michigan, to discover some prospective remedies for mitigating joint pain such as hip and knee replacement surgeries, as well as tips for stopping pain before it starts, on and off the course. A practice offering both hip and knee replacement operations and different approaches to both, Metro Health provides patients with the resources and knowledge to take control of their pain and healing process, and to get back to their game. 

In your own words, what are some of the most common reasons people may need hip or knee replacement surgery?

Dr. Howard: The real reasons out there should be pain and limited activity that can’t be controlled in any other way. Other methods [for control] could include assisted devices like a cane or walker or medications like anti-inflammatory medications or glucosamine.

What are some activities that might wear down these vital joint areas maybe more than others?

That’s the problem, is so many of us were athletically inclined when we were younger and even had injuries, but there are a whole lot of other people out there who have not had an injury and it always shocks them when they come in and say “how did this happen?” You scratch your head, because you really don’t know; it can happen to almost everybody. It’s always surprising too when someone on the small side comes in and they have these joint problems and people often think it just applies to people who are carrying a little extra weight and it’s not—it’s a problem with everybody.

Do you think that could hint at it being genetic for some people? 

They’ve never been able to show that, but we sure see it in familial lines. We’ll see someone coming in who can say “my sister and my brother and both my parents have had their joints replaced or portions replaced” …but we really don’t know. Certainly, post traumatic problems—for people who’ve played a lot of sports—can happen. Maybe someone had a torn meniscus 15 years or 20 years ago and they come in and where that shock absorber was removed many times, they have significant wear and it spreads to other parts of the knee from where the meniscus was removed.

How might a patient know if they end up needing to have hip or knee replacement surgery?

The first thing that’s normally done is they’ll get an x-ray if they’re complaining of pain in their joint. You can look at an x-ray and tell if someone has arthritis by certain characteristics: you’ll see bone spurs forming; you’ll see joint spaces that narrow down; and you’ll potentially see loose bodies or pieces of bone floating inside the knee. All of those are things that we look at on x-ray and of course by the time of the physical examination we verify that any findings we see on x-ray correlate with the location of the patient’s pain. You have to put the mystery together to solve the problem and solve why they’re in the pain.

Would you mind taking me through the pre-op, surgery, and rehabilitation process at Metro Health?

Preoperatively normally, for anyone 55 [years-old] or over, the surgeon that sees you will obviously ask about your medical history, but many times people need to have a pre-op physical EKG and some other things to make sure that they’re healthy enough to undergo the surgery—we don’t want to cause problems by putting someone through surgery. 

Metro offers something called their Joint Camp, which is where people actually go to a conference headed up by Mary Brady…she’s the orthopedic coordinator at the hospital and she answers questions and takes them on a tour, shows them rooms, shows them physical therapy. She really does a nice job of trying to relieve the anxiety, because certainly it’s stressful to undergo any type of surgery; but joint replacement is a one-way trp. Once you take that step, you’re not saying “hang on I want to go back to what I had.” It’s a big commitment and that’s why people really should [consider] all the measures they can prior to undergoing a surgery like that. 

I was reading one statistic that said approximately 5-to-12 out of 100 people need to repeat the surgery in 10 years. It sounds like there’s a pretty good success rate with people needing to repeat this surgery, even in a decade, being relatively low…

Again, there are a lot of the reasons why they may need that that we’re trying to control for as much as we can. Some of the things that may lead to a repeat surgery are if you’re on the heavy side or if you have some sort of immune compromise such as diabetes, or don’t have adequate sensation such as neuropathy. There’s a number of health issues that can contribute to it so if we’re doing a really good job as surgeons, we should be screening for those things and making sure people are making sure of their increased risks and if those are too high telling them that it’s not a good idea to do it. 

The healing process is different for everyone, but typically how long would you say that can take for someone? 

Well, hips recover faster than knees. Most people are starting to do most of their regular activities with their knee replacement at I would say six-to-12 weeks and it varies by the patient; whereas hip replacements I would say between two-to-six weeks people are really getting back to their activity levels.

One of the things that can make a difference too is how they are done. For hip replacements, there are different options for them; the surgeon has a choice for how he does it. You may have read a little about the anterior versus posterior approach and it makes a difference on recovery for people. Most people have it done through the front—anterior approach—and never even have to go to physical therapy. That’s a little bit of the difference, but the success rate on posterior approach is very, very good too. The way it’s done can lead to different times for recovery, so patients are kind of aware of that; they’re looking at the internet. 

In your opinion, what can people like golfers do to improve their joint health? Any tips on the course or before or after surgery?

We know that stretching before and after you play is very important in maintaining your flexibility; that includes not only your lower extremities, but also your back. There are various sources out there that show different golf stretches and it really helps to stay limbered up and stay loose, which means maybe in the off-season doing some form of regular exercise that keeps you moving, whether it’s practicing your swing somewhere indoors or practicing your stretches and exercises on a regular basis. 

Is there any thing you’d like to add?

The other thing that people are doing for their joint health is there are some supplements out there that are helping people stay active longer; one of them is glucosamine. You may have seen Osteo Bi-Flex or chondroitin or Cosamine DS, and there’s all kinds of name brands out there but they all come down to what’s called glucosamine. 

We think that there was a large study by the government years ago that showed that for a certain number of people they had the equivalent pain relief as some of the prescription anti-inflammatories without all the side effects, so I have a number of patients who are taking glucosamine who say “I can tell the difference,” and at the same time we have people who say “I took it and it never helped.” So, it’s like anything, but it doesn’t cost you much and there’s very few side effects or problems with it; why wouldn’t you try it? 

That’s interesting to hear that there’s sort of a supplemental solution like that that’s come out and seems to be helping some people. 

Yes, and there’s multiples of those. Besides glucosamine there’s turmeric. Bromelain is an extract from pineapple and there’s a number of those [supplements]. Not that you want to substitute medicine for those, but many people find those things make them feel better and keep them active longer.