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Distal femoral replacement

 Poster: A snowHead
Poster: A snowHead
I had a mild fall in December and broke my tibia, fibula and femur. It also disintegrated (?) my 10 year old knee replacement. I had two separate surgeries - the first to repair the tibia and fibula, the second to repair the femur and to install a new knee replacement. It is possible (probable?) that the collapse of my knee led to my fall and the major trauma I experienced.

I was 6 weeks non weight bearing, then 3 weeks partial, then progressed to using a cane. At my 3 month checkup I walked in using no mobility aid, to the delight of my orthopedic surgeon. I will graduate from PT this week and the rest is up to me. Currently working on balance, flexibility and strengthening.

The question of skiing next season is currently weighing heavily on my mind. The first surgeon (a skier) who repaired the tibia and fibula, said I would be able to ski again. The second surgeon ( non-skier) who repaired the femur and replaced the knee, said I would (should?) never ski again.

My bone density scan shows only mild osteopenia. I'm currently taking Fosamax.

My biggest concern is that the new knee is a Distal Femoral replacement. This is apparently a knee that is given when nothing else will work due to the condition of the bone. It is normally given to much older people (I am only 69!) who do not have an expectation of engaging in strenuous activity.

My rehab is proceeding well and I am regaining my leg strength. I will probably be in better physical shape by December than I have been at the start of most other recent ski seasons. I have been skiing for 40 years and expected to ski into my 80's. But this type of knee remains a giant question mark regarding my return to the slopes.

I welcome your thoughts.
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
Welcome to Snowheads, @skibum4ever, snowHead I have no words of wisdom to offer, other than "well done for your progress so far".

If it was a "low trauma" fall which did all that damage, there are certainly questions to be asked about the prognosis.

Are you male/female? And where are you based? There are quite a few SHs who have had significant injury and coped very well, and got back to skiing.

What sort of skiing did you do before the injury? What other exercise do you do?
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 Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
pam w wrote:
Welcome to Snowheads, @skibum4ever, snowHead I have no words of wisdom to offer, other than "well done for your progress so far".

If it was a "low trauma" fall which did all that damage, there are certainly questions to be asked about the prognosis.

Are you male/female? And where are you based? There are quite a few SHs who have had significant injury and coped very well, and got back to skiing.

What sort of skiing did you do before the injury? What other exercise do you do?


Thank you @pam w. I am female based in southern California. I came across this forum in googling "distal femoral replacement" and decided to join you.

I was an advanced skier but will be thrilled to return at an intermediate level. I was skiing a groomed intermediate slope in early season conditions. It was not particularly icy, it was well covered, and it was not crowded. I had skied 3 days on the trip and 5 days for the season. I had no idea that I had broken anything until Ski Patrol put me into the sled and I noticed that my foot was pointing at a right angle from my leg.

Right now I am walking 2-3 miles almost every day and have also been going to the gym. I have ITB issues which have so far prevented me from increasing my distance. I plan to start working with a personal trainer now that I have "graduated" from PT.

My biggest concern is whether the type of knee I received will support the stresses of skiing.
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We have a very helpful "knee expert" who sometimes posts on SHs who might come along with advice - though obviously your own medical advisers are your first port of call. It does seem to make a difference whether the docs are skiers themselves, or not, as there will otherwise be a built in tendency to advise against skiing. The fact that you had that accident on easy terrain, and were not even aware that you had injured yourself so badly is concerning. I fractured my pelvis in a relatively low-trauma crash some years ago (collision with large Frenchman) and was able to ski after a couple of months healing, but that was a very straightforward injury which healed well, despite my osteopenia. I have friends with knee replacements who lack the range of movement to walk properly, let alone ski. But they are all elderly! A number of snowheads have reported about skiing after knee replacement. Perhaps it will be a while before you can have any definite indication of the prognosis - and meanwhile working with a PT obviously makes lots of sense.

Good luck!
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Anyway, snowHeads is much more fun if you do.
Thanks. I hope the SH expert will comment on my concerns.

I may have been in a state of shock as I was not in pain during the sled ride down and the trip to the hospital. In fact I resisted pain meds for several hours in an attempt to remain as aware as possible of my options.

My current ROM is better than before the accident and is not a factor.
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skibum4ever, googling "Sport Activity after Distal Femoral Replacement" get you two responses from major orthopaedic centres:

https://www.royalberkshire.nhs.uk/media/hjbplgpa/distal-femoral-replacement-physio_nov20.pdf

https://www.roh.nhs.uk/patient-information/orthopaedic-oncology-cancer/1257-distal-femoral-endoprosthetic-replacement/file

Both suggest skiing might be a bad idea.
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 Then you can post your own questions or snow reports...
Then you can post your own questions or snow reports...
@skibum4ever, …very sorry to hear of the trauma and pain and stress which you are going through. As a climber, skier, city cyclist and mountain biker I have had various ‘exciting incidents’ which have taken their toll mentally and physically, some to do with knees.

It’s vital to get back to active health, that’s for sure. But when you get back to activity, you may need to do a mental reset about the future.

I trashed my left knee in the 80’s. Unstable for years.
I broke my back in 2006. Tricky.

I stopped climbing & mountaineering at the level which I had been doing - and gave up the objectives which I had mapped out. My knee was too unstable, and would put others at risk.

I worked hard to retain skiing, getting coaching to really nail technique, to reduce stress on back and knee. This has been essential to keeping going.

I started upping my emphasis on mountain-biking - really pushing it, so that this could be an all-year sport replacing the objectives I had in skiing and climbing.

In the event, it has been a great mental re-set. Still improving massively in mountain-biking and enjoying lots of new builds of XC and Enduro bikes (Transition, Cotic etc) and my skiing is still going strong, better and better. Mountaineering much more questionable, and it was great to have biking and skiing to fall back on.
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 After all it is free Go on u know u want to!
After all it is free Go on u know u want to!
Thanks for your responses. Yesterday I "graduated" from physical therapy and had a long frank discussion with my therapist.

When we started working together in late January, he was horrified at the idea of my skiing next season. Today he said he knew that once I started feeling better I would want to return to skiing. He feels that it's very possible if I work hard and continue to progress as well as I have in the last 3 months.

I plan to wear a compression base layer and a knee brace on the injured leg. He recommended an ACL brace which will stabilize the knee.
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Thanks for the DM.
If you are happy for my answer to be in the public domain do feel free to cut and paste it in case others find it helpful.
Welcome to SH
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Ski the Net with snowHeads
Thanks Jonathan.

Below is the response I received from Mr Bell. Thanks to those who suggested that I get in touch with him.


"That’s quite a saga. sorry to hear how much you have been through.

I have huge numbers of patients who ski after knee replacement and have never seen a fracture in one of mine but i have seen
Patients who have fallen and fractured, usually, around the femoral component. They can be very challenging cases to manage.

Having said that i have seen some good results of both ones i have operated upon and other surgeons cases.

I only know of one patient who skis post distal replacement.

Her Swiss surgeons view, which i agreed with is that to fracture again around the prosthesis would be exceptionally challenging to sort out and retain a good functioning knee/leg.

However, we know there are some risk in all sports (3 injuries per 1000 skier days).

So my view is as follows:

If you are a “can take it or leave skier” i would think you might feel the risk wasn’t worth it.

If skiing is a passion ( and skiers are about as passionate about their sport as any) and you whole winter is geared up around skiing, skiing friends and family then of course the balance changes to a point where you might accept the risk.

Injury rates rocket when you are fearful.

So i would ask your surgeon if the implant is fixed well enough to tolerate skiing.

I would also advise that if you cant overcome feeling quite scared of falling ie regain your confidence to ski then you may need to stop. Of course you might build confidence on easy , quiet areas with and instructor until your fears have subsided."
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Wow! That's really clear, helpful, advice, isn't it?
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And love to help out and answer questions and of course, read each other's snow reports.
@pam w, as always...
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So if you're just off somewhere snowy come back and post a snow report of your own and we'll all love you very much
At least it wasn't a hard and fast "NO!"
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 You know it makes sense.
You know it makes sense.
I saw the surgeon today for my 6 month followup.

And now I'm in the same place where I've been for two months. To my surprise, the surgeon didn't jump up and down and forbid skiing. He said that the knee is ready for skiing. But...if I fall...it might be a disaster. I will see him again on December 23. So the decision is back on my shoulders.

He went from "You will never ski again" to "You may ski if you want to." My physical therapist made exactly the same leap and was not surprised that I was considering skiing again though he was completely against it when I first saw him.That's a big change and indicative of the progress I have made.
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 Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
@skibum4ever, you're no more likely to fall while skiing as you would walking from the parking lot to your front door! Toofy Grin
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 Poster: A snowHead
Poster: A snowHead
I'm not sure about that, but the truth is that I rarely fall. I told the surgeon that everything in life has some risks, and he agreed. But the consequences of a high speed fall on snow are probably higher than those of tripping on the sidewalk.
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
abc wrote:
@skibum4ever, you're no more likely to fall while skiing as you would walking from the parking lot to your front door! Toofy Grin


Depends how hard you're trying wink

But yes, the OP choosing to ski more slowly and/or on gentler slopes than before ought to be able to ski without any real risk of falling, as long as she's able to avoid being hit by anyone else.
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 Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
Quote:

But the consequences of a high speed fall on snow are probably higher than those of tripping on the sidewalk.

I wouldn't be too sure about that. But skiing more carefully, watching out for potential collisions, avoiding crowded pistes, makes eminent sense. Carrying on as you were before, probably doesn't. People vary in how they react to having to pull their horns in, to cope with age or injury. I have a lot of sailing friends - including one who was a top dinghy helm in his day, and done a lot of ambitious cruising and racing since. He's now 88 and does none of those things. I crew for him - and am impressed with the way he's adapted to an old man's way of sailing, in an old man's boat (with two loos, an excellent oven and a fine store of wines) with old lady crew. But I have another friend who was never so ambitious, or as experienced, but did some good trips, with family, back in the day. He now has health problems (so does the 88 year old, don't we all....) and because he is no longer as gung-ho and confident as he was, and is a bit fearful of biting off more than he can chew, is ready to give up, and feeling miserable about it. I'm trying to persuade him to adapt to easy sailing in good weather - but as a perfectionist, this is very hard for him. Allowing the best to be the enemy of the good, as perfectionists tend to do! rolling eyes
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Yes, a good friend has volunteered to lend me a pair of less demanding skis and to escort me on my first ski day. She said that she is willing to stay on beginner slopes with me for as long as it takes to restore my confidence.
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 Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
@pam w, it depends on what one gets out of skiing.

Some people like skiing for the thrill. They wouldn't do very well "pulling their horn in". Others just enjoy the sensation of gliding effortlessly on snow. Those would easily adapt to taking it easy.

I've had to do some serious soul searching regarding mountain biking. Because I enjoyed it for the thrill. It's really annoying to not ride all the risky technical sections/trails.Sad But I have no problem skiing casually.
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You might find yourself surprised at how you react, @skibum4ever. After I broke my pelvis in a collision it healed up well and I was back on the slopes a couple of months later, with good friends who were prepared to keep me company. We headed for an easy blue slope which I knew well but I found that what freaked me out was other people - so we headed over to a deserted, and actually very easy, black slope which I enjoyed because I could relax. Gradually, of course, I got used to other people being around! But objectively, although I was scared of a collision, a fall should not have been a problem - the newly healed bones in my pelvis were stronger than they'd been to start with. But when a fall could be very serious for you, choosing your time and place for skiing will continue to be important. Best of luck with it. Little Angel
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 Then you can post your own questions or snow reports...
Then you can post your own questions or snow reports...
abc wrote:
you're no more likely to fall while skiing as you would walking from the parking lot to your front door!

And abc could well be correct.
But as pam w mentions, falling is not the real problem.
Collisions with other skiers is the problem.
Walking in the parking lot, (almost) everyone else is also walking. If they bump into you: no worries.
But lots of other skiers are going fast: some too fast and not fully in control.
Collisions happen. Collisions are dangerous.
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 After all it is free Go on u know u want to!
After all it is free Go on u know u want to!
Jonpim wrote:

Collisions happen. Collisions are dangerous.


This is true, of course, but collisions where one party is completely blameless and could in no way have avoided or prevented it are astonishingly rare. When skiing, like driving, one needs to be aware of everything around you, especially above you, and treat everyone as a potential hazard.

But actually, most of the time someone who is hit by an out-of-control skier is stationary, so there are various strategies that can help, most of which might be thought of as common sense, but at the risk of appearing condescending, I'll list a few here anyway; if anyone's got any other special tricks please add them to my list.

Stop right at the edge of a piste, on the uphill side it it's cambered. Try not to leave any skiable terrain behind you.
Always keep looking at the slope above you.
Wave your poles around, pointing them uphill. This is an instructors trick to ward off others from coming too close while they focus on their students - lots of people think it's OK to pass within half a metre of someone, even a large group, stopped, but they tend to be much more cautious if there are spiky poles pointing in their direction.
NEVER sit down.
Don't stop wink

I've seen one-sided collisions, of course, but they can nearly always be avoided if you take enough care in the first place.
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Chaletbeauroc wrote:

Wave your poles around, pointing them uphill. This is an instructors trick to ward off others from coming too close while they focus on their students - lots of people think it's OK to pass within half a metre of someone, even a large group, stopped, but they tend to be much more cautious if there are spiky poles pointing in their direction.

If it makes you feel better, keep doing it. rolling eyes

Collisions are almost never intentional. When an out of control skier collides with another, they had already lost the ability to change course to avoid the collision long before the actual impact. Pointy poles or not, the trajectory will remain the same and the collision will happen.
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One near collision I had (my fault) I saw two people weaving back and forth across the slope so decided to not slow down and just go off piste into deep snow about 4 yards and go round them. Blow me! instead of weaving back across the piste as I was about to pass they went off piste to where I was about to be, and I stopped, as I took a jump off an edge rather than risk going between them. No problem by the way, but I slow down now.
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