Knee replacements and skiing

A snowHead

My dad had a knee replacement last year (aged 73) and has been trying to get some straight answers from consultants about what he can and can't do.

The two consultants he has seen have both avoided the subject of whether he'll be able to continue skiing with his bionic knee, possibly because neither of them ski themselves.

Apart from the knee he's very fit and healthy, and would love to ski again. We are probably going to go on a ski holiday with both my parents next season. He says he's content to buy some snowshoes and do that instead, but I know he'd really love to have the confidence in his knee to be able to ski again. I dont think that its bending the knee that is the problem, its the torsional stress that he may subject the joint to that is causing the worry.

So, anyone out there got any experience of skiing with a knee replacement?

Thanks for any advice from both me and my Dad.

A snowHead

Dave J, Mrs/Dr L's dad had one knee done about 15 years ago (then mid-60s) and his other one a few months ago. The consultants told him not to resume cycling, both times. However, cycling was/is so fundamental to his quality of life, that Mrs L (a GP, not an orthopod) advised him to ignore the consultant. She was, as usual, 100% right. Not saying this advice necessarily translates to another person and another activity, of course.

Well, the person's real but it's just a made up name, see?

laundryman,
Thanks. I probably should have added that I appreciate that this is not a medical forum and that advice will not necessarily be based on sound medical research!! But any advice will still be welcome.

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laundryman, cycling is a low impact sport skiing is not.

I've got a fair amount of orthopaedic experience, and I would advise your father to avoid skiing with his new knee. I'll expand on this tomorrow when I've got more time.

Anyway, snowHeads is much more fun if you do.

Dave J, There are some MDs here that will no doubt post some advice. Knowing how the knee works, due to various surgery, I would suggest that gentle X country skiing may be possible but would suggest that downhill skiing was definatley out. Just to much possible stress on the joint. I hope to still be skiing at 53 never mind 73. Get him to retire gracefully.

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Had to answer the phone part way through writing thhe message, and look the Dr pops in for a chat

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Not quite skiing but I know an oldie climber who still climbs and hikes after his knee replacement.

After all it is free

Frosty the Snowman, waddayamean "I hope to still be skiing at 53" Shocked

I shall be 60 next season. I defintely hope to be still skiing then Toofy Grin

Unsurprisingly most meccano men would advise forgetting about alpine skiing after TKR. It is potentially high impact which would damage/loosen the new knee and accidents do happen which could damage/loosen/dislocate the new knee and fracture surrounding bone which could be very bad news indeed for walking, much less skiing. If I were a meccano man, I'd definitely tell my patients to go Nordic and gentle Nordic at that. And don't even think about telemark!

This [url=http://www.jointreplacement.com/xq/ASP.default/pg.content/content_id.364/mn./newFont.2/joint_id./joint_nm.''/local_id.0/nav.rehab/qx/default.htm] is typical[/url].

This is a more objective view http://www.totaljoints.info/TOTKNEE_and_sports.htm

This is out on a limb Laughing

http://www.kneesociety.org/index.asp/fuseaction/site.totalKnee

ps I've got to admit that if it were me I'm not sure I'd be able to swallow my own prescription, though I'd take great care with the circumstances

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Dave J, This came up a few months ago while talking to my mum's knee consultant (she's on the list for two) and he concurs that after surgery and until full strength is back to the surrounding connective tissues you should limit yourself to very gentle nordic. Once strength and mobility is back (and in most of his work his patients are in pretty poor shape due to delays and age), which could take at least a year of very hard work for someone who's been debilitated by long-term inactivity, then gentle non-aggressive skiing (blues and greens) could be ok. and he'd insist you wore good knee braces too.
He is a skier, but before he said ok to anyone he’d want to see them first before letting them go . . . if at all.
He also said that standards and type of implant and quality of surgery and aftercare can vary considerably . . . he should know, he’s a knee man.

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I know a dutch surgeon who had a knee replacement and carried on ski-ing. He is very fit (and quite young), and I believe he doesn't try anything tricky, off piste of ski in slush, but he does ski.

Frosty the Snowman, Are we all to be pensioned off? I'll be 53 in 2 weeks time - perhaps you'd like to ask my bash students if I should reture? (No, don't answer that).

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easiski, Nick Zotov, My Dad is 78 and has fantastic knees. Me, I am 43, 123 kg, 6ft 4", and have had 4 big knee ops during my 20yr rugby career and now have fairly well developed arthritis in both knees. Another 10 yrs skiing would make me a very happy man, but if I was 5ft 10", 85kg, hadn't played rugby or seen a surgeons knife then I would have loved to ski till my 70s. But I would have missed out on 20 wonderful years.

I would love to ski for ever, and have even considered radical steps such as getting fit and loosing weight wink

BTW, Thanks mods/admin. I don't know how to do that. Is there a thread somewhere? or am I just ignorant?

You know it makes sense.

slikedges, no worries mate Toofy Grin

try here for a few tips. Look under "BBCode" on the menu.

Otherwise you'll just go on seeing the one name:

I've had a number of knee operations (not TKR though) and I got a custom titanium brace to keep on skiing. It's the same type racer Tommy Moe used to use (a Ti2) and it has served me well for 8 years. They are not cheap, but nothing about skiing is, and the brace does its job very well -- distributing load from joints to muscles. Like many people who have had to come back from knee incidents, my skiing envelope is smaller than what it used to be. I have to ski slower, on less steep terrain, and avoid high energy transfers.

Hopefully, your family member will be able to partake in this sport/hobby again in some kind of fashion.

A snowHead

AKR, welcome to snowHeads

A snowHead

Frosty the Snowman, "and have even considered radical steps such as getting fit and loosing weight "

Always a good idea anyway. Very Happy

Well, the person's real but it's just a made up name, see?

easiski, The opinion of the medical profession is always an influence on ones life, but when an EOSB legend suggests something the one has to "make it so". Shall check back in an hour coz iam off out on the bike. Very Happy

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slikedges,
Thanks for the links. Some handy straight talk on the second one.

'Skiing: cross country skiing and downhill skiing on flat slopes loads your new total knee with about 4 times your body weight, slightly less than speedy walking. Downhill skiing on steep hills overloads your new knee with up to 8 times your body weight. '

It also says that nordic and 'stationary' skiing should be Ok, whatever that is Puzzled

Thankyou all for the info.

Anyway, snowHeads is much more fun if you do.

Back in from the bike ride it was windy, but the knees not quite so sore after an hours rest.

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Dave J, Pleasure.

Then you can post your own questions or snow reports...

Sorry to hijack the thread but it's a knee related question. The last few days I've noticed one of my knees "clicking" as I walk down stairs. It doesn't hurt, but the noise does make me squirm (a bit like cracking knuckles). I spend quite a bit of time in the gym (4/5 times per week) but I'm not training for a marathon or anything - just 20 mins on treadmill, 10 mins cross trainer, free weights, squats etc, tend to steer clear of resistance machines. Anyone any ideas what it could be and how / if I can make it go away?!

Cheers!

After all it is free

My father had both knees replaced 5 years ago, he was playing badminton within a year and did so for 2 years with out problem. He has just had one of the knees replaced last Tuesday because it worked loose in the bone not sure whether it was due to deterioration of the bone or adhesive failure, his surgeon thinks the latter. I asked the surgeon about skiing whilst I was visiting, he was of the opinion that it would depend on the individual and muscle fitness but could see no major problems on easy runs ( the surgeon was a skier) but he did say no moguls.

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Interesting..!!

A friend of mine was considering knee surgery on both knees but this may put him off.
He walks very badly and has very little cartlidge...the prognosis is not encouraging and when he visited
a physio and showed what he can do the phsio said that she thought she could get him walking again...
"Bugg** that, he said, I want to go skiing"....the physio had to sit down for 5 minutes presumably in a state of shock....... It really depends on the person, medical advise will be conservative and maybe rightly so
but his guy is still skiing and does struggle but you want to see want we take him down....they aren't no gentle blues.... Foolhardy...? I don't know, and by the way he is 74....!!!

Before you flame me for this..... he WANTS to do all this..and we couldn't put him off if we tried..!!

Just an alternative view..!!

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Had a chat with the Knee Doc this after’ with the following ‘unofficial’ advice:
Tel your dad to get the exact make, model and serial number of the implant he’s had fitted, and research it’s metrics. It seems that the elderly are commonly provided with mechanicals that have a range of movement limited to about a 90° arc. There are others that provide a much greater range of movement. If he has the later, has rehab’d properly and he was a good controlled skier beforehand, then there should be no problem or issue with him returning to recreational skiing on groomed piste. Wearing a mechanical stabilising brace is strongly recommended.
Skiing with an implant that has a limited range if movement could be disastrous and is NOT recommended.

There are some serious issues here and I’m loath to raise the prospect of negligence or liability of either party, but . . .

If he’s been fitted with an implant that’s not suitable for his lifestyle and he told his consultant/surgeon about his recreational activities beforehand, then he may want to have an informal chat with a medical negligence solicitor.

But he needs to do his research first.

snow reports

Kramer, why?

You know it makes sense.

First of all, because fighting medical litigation is a huge drain on NHS resources, pouring money into the pockets of lawyers, away from the treatment of patients.

Second, spurious litigation is slowly changing medical practice in this country to make it more "defensive", this is not to patients benefit.

Third, because there is no way on earth that this surgeon has been negligent in this case, and to suggest so may damage the doctor patient relationship.

Fourth, because introducing lawyers to a situation rarely helps resolve it IMHO. (apologies to all the lawyers on this site!)

Otherwise you'll just go on seeing the one name:

Masque, I would have thought solicitors a bit OTT, but surgeons certainly should consider the patients' lifestyle and they often don't.

As the child of 2 elderly parents I see it first hand - they're old - they don't matter - they can veg - it's OK to leave them alone for hours - it's OK if their quality of life is rubbish after treatment - they're old after all - what do you expect?????? I get the distinct impression from our local NHS (2 different hospitals) that elderly people definitely DO NOT COUNT. Sad

A snowHead

I couldn't comment on individual cases, but to suggest that elderly people "DO NOT COUNT" in the NHS is just not true. The vast majority of the NHS patients are elderly, especially in orthopaedics. As someone who works in the NHS, I find that sort of statement quite insulting. Sad

A snowHead

I thought one of our ‘white coats’ would rise to this.
Let’s clear the air first. I have enormous respect for the medical profession as a whole. They commit to a very steep and continuing learning curve, acquire responsibilities that few of us could contemplate and work within a system that sees then as just a resource.

External to that are advances in techniques, pharmacy, equipment and prosthesi that do maintain and enhance quality of life for all of us.

Treatment decision making by doctors is supposed to include the patient (but I have first and second person knowledge where this is not the case). where a treatment regime is conducted for the expediency of the Trust or to fit within the skills or time limitation of the surgeon in contradiction to the best interest of the patient then the patient has every right to seek redress.

Kramer, Are you prepared to state that all Trusts and treatments use the newest developments and techniques? Or that when a patient clearly defines their work or recreational lifestyle, an inappropriate treatment regime is NEVER undertaken?

It’s an uncomfortable fact of life that, for reasons beyond their control, all the surgeons that I’m in contact with 6 out of 6, place cost and expediency first in their decision process. The patient is never at risk but their post operative life is someone else’s issue.

As a point of fact, if I hadn’t researched my Achilles repair and insisted in writing on the type of repair I required to continue an active life, I would have had a simpler and ultimately weaker restructure as explained “to suit my age”!

Kramer, Your response to "why" is very one sided and only addresses the NHS CYA liability and not this patient's rights. I understand your defense reaction but to categorically state that the surgeon has not been negligent is facile. Neither of us know the full facts in this situation, hence my advice to research.

Well, the person's real but it's just a made up name, see?

easiski, I'm cannot know the circumstances of your experience but it is unfortunate that the pressures on staff are such that the persistent but pleasant nagger often gets dealt with earlier. Second thing is that sometimes it just isn't possible to fix the elderly. Sad

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Russell, Dave J, JT, Medical advice is just that: advice. What you as an individual choose to do is ultimately your decision. It doesn't really affect the doctor, though he may actually care about the well-being of his patients. Of course, as there are those about only too keen to seek redress by due process Masque, most doctors' advice will be conservative. Biological variability means that what is right for most is going to be wrong for some, so that as you can't predict the patients who could actually get away with more, it's best to tell everyone to take it easy. I think the bottom line here is that gentle alpine skiing is ok for most, as long as you don't have an accident and you're willing to take the chance that it just wasn't ok for you.

Anyway, snowHeads is much more fun if you do.

Masque, the gentleman in this thread has had a knee replacement and now seeks to go skiing, from that I infer that his knee replacement functions pretty well. That is all that I need to know to suggest that the surgeon was not negligent. If the patient was bad enough to need a knee replacement before his operation it is highly unlikely that he was skiing during those years. To suggest that all specific activities that may or may not be possible after such an operation should be discussed is impractical and unrealistic. People should be informed of the common or serious risks and the likely benefits of an operation, any more than that and it gets far too complicated. To suggest that an implant should be chosen based on possible activities after surgery is more likely to be negligent IMHO, there are far more important issues to be considered.

Spurious litigation, and the threat of litigation are a serious and growing problem in the NHS, one could argue that instead of reaching for a lawyers telephone number, many people would be better served either by seeing a grief counsellor, or by coming to terms with what is exactly possible in modern medicine. Anger is a natural part of the grieving process, unfortunately in the modern "blame culture" in which we seem to be living, there are far too many people who want to exploit that anger, or suggest such a course to other people.

You raise the issue of redress. Now I'm not denying that this is needed in cases of professional negligence, but there is a growing attitude that if something bad happens to you as a result of a medical treatment then you are deserving of compensation. Again this is not a realistic attitude, poo-poo happens sometimes, and there is nothing that can be done to prevent it. Sometimes treatments don't work, and there is not a respectable medical practitioner in the world who can deny that. Similarly to expect superhuman levels of competence from clinicians is unrealistic.

You also ask whether the newest treatment is available in every hospital, no it isn't and I for one am glad. Your belief that newer equals better is naive when it comes to medical technology. There is a very strong argument for only having a treatment that has been in popular use for at least twenty years, to give us time to assess the risks and benefits. Most "new" treatments turn out to be no better than old ones when assessed properly, and sometimes can even be worse. Invariably they are more expensive, which is an issue when there is a limited amount of money to be spent.

I can't comment on the attitudes of the surgeons that you claim to know, but I can comment on the attitudes of the surgeons that I have worked with for the past fifteen years, and they always strive to put the best interests of patients first, in my experience.

I'm off on holiday now, so I won't be posting on this subject again. My yacht awaits me in Split. Very Happy

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slikedges, I don't disagree and I don't recommend running off to the law, but there is an issue here that needs addressing and is relevant to all of us who are getting older and who undertake a sport that has a history of knee injury.

If there were only one knee implant prosthesis and technique then there’d be no issue.
However, replacement joints are continuously being researched and developed, reconstruction techniques are changing year on year, surgeons go to international seminars and trade shows to share their experience and evaluate these developments.

If a patient informs their doctor that they have a work or lifestyle that requires a specific procedure or treatment and then the doctor or Trust options to provide a lesser or inappropriate regime, without informing the patient, then as far as I’m concerned, not only have they defrauded the patient of his rights but they may also have committed an assault to the patient.

As much as Kramer decries the waste involved in claims against the NHS, he cannot deny the validity in many of them. He does not work in a perfect system nor a perfect world. And we don’t live in one, but we don’t want to be screwed by the system that’s supposed to help us and when it does, indignant protestation does not mitigate bad practice . . . if that is the case.

That’s why knowledge, research and ensuring the safe return to skiing of a sportsman are the first goals in this thread.

edit:

Kramer: This was posted before I read your last post . . . so no worries, but I think it's a subject that deserves more interest in the long term . . . enjoy your sailing snowHead

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Having a pair of knees suffering from years of playing squash I found this thread very rewarding to read, until the lawyer bit got in.

The advices from the medical profession here has been first class and that is what we skiers need to know.

beanie1, My knees have been clciking for years. The click doesn't hurt but doesn't go a way either.

After all it is free

Dave J, to sum up for your father.

If he skis again-

He has an increased risk of fracturing around his prosthetic knee joint.

If he did fracture around the joint, repairing the fracture would be complex, and risky.

He has an increased risk of the joint wearing out, or loosening. Both of which are a major cause of re-replacement, which is the major problem with this surgery.

To my knowledge, current practice in this country is to hold off doing a knee replacement for as long as possible, because younger more active people wear them out more quickly, leading to more serious problems in later life. Having seen what happens when a knee replacement goes wrong (which is far more common in redo operations), I personally would not partake in any behaviour likely to make a repeat operation necessary.

Masque, you may respect the medical profession but it doesn't sound like you have much consideration for them, nor understanding of the nature of their work NehNeh

Why do you want Kramer to “state that all Trusts and treatments use the newest developments and techniques?” You well know it would be ridiculous to expect anyone to make such a statement in relation to any occupation from piloting public transport to professional armpit smelling rolling eyes

. It takes a finite time for knowledge to disseminate, techniques to be learned and facilities to be made available. Even if you have immense power, wealth and time Twisted Evil

the reality is we all accept service from our bus drivers and bus designers, builders and civil engineers, laundrymen and lawyers, plumbers and prime ministers that is ultimately only of whatever is the currently acceptably high standard.

Or to state that “when a patient clearly defines their work or recreational lifestyle, an inappropriate treatment regime is NEVER undertaken?” Which perfect world do you live on where you may be righteously indignant when not honoured with flawless service in every industry (or have you just made medicine a special case?), and how do I get resident status wink

? All experienced doctors try to tailor treatment to the individual. Nevertheless the result is often a compromise due to conflicting factors, which in this day is always discussed with the patient preoperatively, particularly where a specific concern has been mentioned. If preoperatively Dave J’s dad had stated he wanted to ski again, the surgeon would likely have advised against it, but if unable to dissuade would certainly have put in implants more suitable for skiing unless there were other overriding factors, in which case the surgeon would likely have explained the situation to the patient. If skiing was not mentioned and the knee works as it should otherwise, there is no case to answer if the patient now finds the implants are unsuitable for skiing.

I am sorry your experience of these surgeons was so negative. However, what you are alluding to is that you were offered what was not the latest or best treatment for your case because there wasn’t a convenient surgeon around who could do it or could be bothered to do it? I hope that all surgeons will always be bothered for their patients. I'd like to think that if there was a capable surgeon, it was again down to the availability of facilities/equipment. But I’m afraid that when a field progresses quickly, sometimes expediency does come into it. There are certainly many conditions where rapid treatment in the form of the outgoing gold standard is better than waiting to see the world leader in Johns Hopkins who has an 8 month waiting list and who charges a US$64000 personal fee for the procedure if you fly in wink

. That said I'm glad you eventually got what was right for you. snowHead

Edit:

My turn! Hadn't read your last post to me!

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I know two people who need new knees, neither can walk very far. One wants a reasonable quality of life and hopes he will be able to play golf more...- he needs two replacements, and the other I've mentioned wants to continue skiing. The latter should hold off until his natural knees give up completly by the sounds of this thread as new knees are just not any substitute. Obviously the knee is a hugely complex joint and just cannot compare with expectations people have for shoulder and hip replacement.

And..talking to an expert orthordontist about knee replacements which he is interested in, he said he wouldn't go near a lot of surgeons in the NHS for this type of Op' ...he put it a bit differently but the jist is correct, and he was amazed at some of the antiquated types of adhesive that is still in use.

I think his point about the surgeons and was that he is an expert in his field, ie, a renown Dr, and would want a comparable for his operation. Lucky to have the choice..!!

Help!!

Knee replacements and skiing

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