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Evidence-based Golf

Using "evidence-based" in the title of any healthcare article can welcome criticism, as recent Lancet editorials and letters show only too well. Since Bandolier knows how to enjoy the occasional round of golf, one of our (benign) critics challenged us to write an article on evidence-based golf!.

It was an instructive challenge. Using "golf" and "knee" as free text identifiers, MEDLINE was searched between 1991 and 1995. Three articles were identified, none of which was a randomised controlled trial. That didn't mean that they weren't interesting, however.

Golf injuries in amateur golfers [1]

Questionnaires about golf injuries were sent to all 461 members of the Royal Worlington and Newmarket Golf Club in 1991 - including gentlemen, lady and university members. Replies were obtained from 41% of gentlemen and 47% of lady members - university members not being mentioned. The average age of responders was 50 years, who had played golf for a mean of 30 years, and who played about four rounds a month. Variation was wide!

Seventy-two injuries were sustained when playing golf by 61 golfers (of the 193 members replying). Of the golf injuries of eight women, seven involved elbow, shoulder or wrist. Men (53) had more varied injuries, the most frequent of the injuries reported being wrist (15), back (13), and then injuries to various joints and extremities. Impacts by balls (6) and clubs (1) were relatively rare, as was attack by bees (1).

Sport after hip or knee replacement

What activities are recommended for patients with a hip or knee replacement? Again no randomised controlled trials, but there is at least some collective opinion about what might be recommended or not recommended. It comes from a survey of consultant surgeons and fellows and senior residents involved in orthopaedic procedures at the Mayo Clinic [2].

The main part of this study was a single page questionnaire which asked the surgeons whether they would recommend regular patient participation in particular sports after surgery for each of 28 sports. The results are shown in the Table.

Recommendations for resumption of various sports after knee or hip replacement by Mayo Clinic Surgeons

Recommended Intermediate Not recommended
Golf Hiking Squash
Swimming Cross-country skiing Ice-hockey
Cycling Speed walking Baseball
Sailing Backpacking Running
Scuba diving Ice-skating Water skiing
Tennis Karate
Ballet Basketball
Aerobics Soccer
Alpine skiing Rugby

To be recommended or not recommended required more than 75% of surgeons agreeing; between these scores the classification was intermediate. Some sports have been translated into their English equivalent; cricket was not mentioned. Cross-country skiing was recommended after knee but not hip replacement.

95%) and sailing were recommended for both; recommended sports were supported by more than 75% of responders. A range of energetic and contact sports were not recommended by more than 75% of responders - including karate, soccer and water-skiing. Other activities, like tennis, ice-skating and aerobics had intermediate scores, and were neither recommended nor not. This paper had a literature search to identify reports on hip or knee surgical procedures and sports. In active golfers who had a knee replacement in the USA, the majority report a mild ache while playing, usually on the target side [3].


  1. ME Batt. A survey of golf injuries in amateur golfers. British Journal of Sports Medicine 1992 26: 63-5.
  2. BJ McGrory, MJ Stuart, FH Sim. Participation in sports after hip and knee arthroplasty: review of the literature and survey of surgeon preferences. Mayo Clinic Proceedings 1995 70: 342-8.
  3. WJ Mallon, JJ Callaghan. Total knee arthroplasty in active golfers. Journal of Arthroplasty 1993 8: 299-306.

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