Advice From An Orthopedic Physician.
A reader asks:
I need a knee replacement. Is there one implant (Zimmer, Depuy, Stryker, etc.) that is better for returning to skiing?
Here’s the reply from Dr. Peter Schmaus, Orthopedic Spine and Sports, Paramus, NJ:
Thank you for that interesting and timely question. There are nearly 700,000 knee replacements done in the United States annually and that number is increasing. Many of these adults participate in snow sports and wish to continue skiing. More conservative orthopedists in the past have advised against skiing with a total knee replacement and especially with a total hip replacement. However there is no clear evidence that when skiing within limits, a total knee replacement presents a problem. Logically, experienced skiers in good physical condition should fare better. A novice skier may however present more risk. Reducing impact , perhaps avoiding the bumps and limiting significant knee flexion would be prudent. Cross country skiing should present no problem at all. Advances in equipment have also contributed to reduced risk.
There is no academic work showing disproportionate loosening or wear and tear of the prosthesis, and no one brand of prosthesis to my knowledge is superior to another.
There may be extenuating circumstances in regard to other coexisting orthopedic conditions and participants should asses the risks and benefits with their orthopedist and ideally, work with a physical therapist experienced in snow sports.
I replaced both knees, six weeks apart, 3 years ago. I ski 75 to 80 days a season without any knee pain. Best decision I ever made. I am 69 and plan to ski well into my 80s.
A couple of thoughts:
First make sure that you get an “athletic knee”. The standard knee requires cement to put it in place. After a while, the stress forces of skiing and other sports can cause the cement to crack. This forces a replacement. But the replacement process requires the cement to be chiseled out which results in significant bone loss. And that makes the replacement less successful.
An athletic knee does not use cement.Instead the knee is fit into place and the bone grows into the metal. Also, make sure that your athletic knee does not require the loss of the PCL. With either a standard knee or an athletic knee you will lose your ACL. But I have not experienced any instability without the ACL. (one side note, I am in the gym three days a week with an upper and lower body weights workout)
I had my knee replacements done by Dr. Thomas Rosenberg in Park City. He is considered one of the very top knee guys in the country. Unfortunately he just retired.
My suggestion to locating a surgeon is to ask several physical therapists in your area who they would go to for a knee replacement. They see the wreckage from the incompetent ones and know who the really good ones are.
Athletic knees are significantly more difficult to do since they must be very precisely fit. So I would require the surgeon to have been doing athletic knees successfully for at least ten years.
Finally plan on three to six months of significant physical therapy. It is absolutely not fun, but critical to regain your function. I was skiing full days five months after my second knee replacement.
There is now in 2019 modern STAR TREK level of prosthesis from a firm out of Massachusetts going by the trademark name, CONFORMIS.
THESE ARE NOT OFF THE SHELF UNITS.
Each is made to PRECISE measurements using
3-D imaging. And 3-D technology builds it.
The surgeons are qualified and trained in the CONFORMIS in addition to their normal orthopedic chores and are located all over.
Consider the CONFORMIS to be a bespoke knee replacement. There is nothing else that comes close.
According to Dr. Rosenberg and Dr. Momberger the Conformis statistically does not have better results than any of the other knees. I specifically asked this question.
I had my right hip resurfaced (birmingham hip replacement) here in Australia and resumed snow skiing 1 year later, now 14 years on, my hip feels great.
I do train weights 3-5 days a week to keep the strength up which helps as well, Im 59 years old.
Greg
I realize the question is about knee replacement. The question mentions hip replacement as a certain no for skiing. I have had both my hips replaced about 15 years ago. I have been continuing to downhill and cross country ski for the past 14 years. I don’t do the moguls or push any limits in downhill skiing. Cross country skiing I do all terrain.
As the response indicates find an excellent surgeon. I had my surgeon narrowed down to three in the state before I had my surgery. Do your homework.
Thanks for the encouragement! I have 2 hips replaced 2004,and 2018 and haven’t skied again but seeing that you still do, I hope for good snow this year!
I’ve had both knees replaced about one year apart. As stated above, absolutely the best decision. It’s like going back at least
10 years, maybe 20, in my athleticism.
My surgeon and a friend who is an ortho product rep recommended the DePuy Attune prosthesis (implant). It is fantastic. Having an experienced surgeon who uses that prosthesis frequently is also important.
Super stable from the first step. Great range of motion now. Playing competitive doubles tennis, biking, skiing, going up and down stairs with no problems.
As noted, the rehab is critical for a good result. I did 8 weeks in outpt PT, twice daily exercises at home for 3 months, then once a day to 6 months. I continued to improve after surgery for at least 18 months.
The only “but” for me was the first 8 weeks postop the first time. Just because I was so limited in activity and so bound to the exercise program, I questioned every day whether I had done the right thing. After that, absolutely no question that it was the right thing to do!
Email me if you’d like to talk.
Brad
Hi Brad, can you tell me if the surgeon was In Massachusetts ?.. I am only 63 yo and have skied, run , hiked and kick boxed most of my life. The last year has been horrible not being able to do any. I am scheduled for a TKR in March and hope I picked the best but won’t the best brand type also … Can you advise anything thoughts , comments or questions…thanks
How long do you wait until you decide to get the surgery for knee replacement? I still walk fine and ski, just not as well, and not as long and not as pain free as before. I can ski a couple of days, each day no more than 3 hours, before I have to take the next day off. I used to ski all day, and many days in a row.
The Doc says wait till you are ready. (What does ready mean) its a tough decision for me!
At 70 I’ve had my left knee replaced three times, none due to skiing but from hockey. I use a simple neoprene brace with side support and Velcro straps that gives me the support I need. I’ve skied >40 days this year without an issue.
After having both knees replaced (2013 and 2015), I can say that it was the best thing I have done in order to ski pain free. Having skied for 30+ years, I had to find a surgeon who would agree that skiing was still possible, therefore I had my surgery done out West, with a fairly young, definitely progressive surgeon. He also is one of the developers of the DePuy device, so I knew I was in good hands. PT is a MUST, and keeping fit is also part of the routine, but I am skiing still, and plan to ski well into my later years. I don’t do bumps (on purpose, anyway), but am still able to ski as aggressively as I used to. There is life after TKR!!!
I am 108 days post right knee replacement with left knee replacement planned for September 2019. Great team here in Truckee, CA. As mentioned, the PT is not easy, but I keep remembering I need to buy my Icon and Epic passes in the next few weeks to get some late winter/spring skiing in 2020. One of the primary reasons I am doing this is to ski. I could manage most things, but first nordic was no longer an option. Then, last year I realized through tears I could not tolerate the pain alpine skiing. I can’t fail as skiing is our winter life.
I’ve had three partial knee replacements, Left medial, Right medial and Left lateral, with the last one in 2017. I’ve had generally good results and quickly resumed golfing and, more cautiously, skiing. Last year I saw a reference on this site to the SkiMojo system. I went on their web site and was intrigued enough to do their trial program.
It works great! It rides along the knee joint under the ski pants and is undetectable. Best of all it reduces the felt weight on the knee joint and provides some lateral support. I’m back to skiing steeps and bumps without difficulty. It extends my runs, my ski days and my season. Today was day 49 at Deer Valley and almost 800,000 vertical about half of that off piste. Highly recommend!
I will be needing new knees soon. I am getting my first Orthovisc treatment now. I have heard that some knee replacements have limited range of motion. I am a 69 year old tele skier. I need a fair amount of range of motion for that. Anyone have suggestions?
Hi David — I had left knee replacement at age 69 like you, an am a back-country telemarker still (now 73 years old). It may not actually matter much which brand of knee joint you get, but you absolutely do have to get one that BOTH screws into place (the “athletic” type) AND is cemented in. Otherwise the many small impacts of skiing are likely to cause a crack in the attachment. Once it cracks you need a “revision”, i.e. a new replacement, which is much more difficult than the original. No matter what, you are probably looking at a small reduction in range-of-motion, but that just means your telemark position can’t be quite as aggressively deep. No more knee on top of the ski! I just don’t ski quite as aggressively as before, but still get in more than 70 days per year. Good luck! — bodie jack
Hi Jack, can you tell me the brand used that does both screw and is cemented into place .. Thanks
We love cross country skiing (nordic skiing) but by the skating style. This has more torque on the knee than the classic straightforward style. We cannot find any information on whether skate skiing is ok after knee replacement.
What do you know?