Orthopedic expert Joseph Assini, MD explains how active adults can enjoy downhill skiing, even after a knee replacement.
If you have been active for most of your life, chances are by the time you get into your 50s, you have experienced knee pain. For many Coloradoans, this means a disruption to a beloved activity—downhill skiing. “Many of my patients have been avid skiers throughout their entire lives and that is important to them,” Joseph Assini, MD, an orthopedic surgeon at OrthoONE Swedish Medical Center reports. “When they get into their 50s, 60s, 70s now they’re finding that it’s no longer possible because of pain in their knees. They often wonder about knee replacement, but they want to know if that will allow them to get back to skiing.” The good news, Dr. Assini encourages, is that skiing after a knee replacement is absolutely possible for the right patient.
What is a knee replacement?
The knee is a complex joint made up of three compartments: medial (the inside), lateral (the outside) and patellofemoral (the front). Within these compartments are three bones: the femur (thigh bone), patella (kneecap), and tibia (shin bone). Over time, the stress placed on the knees by sports, injury and general activity causes the cartilage to wear away, leaving the bones to rub against each other. The result is pain and stiffness, which can become debilitating over time and lead to a significant decrease in quality of life.
“The goal of knee replacement is to restore function in the knee and alleviate discomfort,” Dr. Assini explains. “Depending on the specifics of the patient’s needs, we may perform a total replacement or a partial replacement, both of which can be done with minimally invasive techniques.”
During a partial knee replacement, only one component of the knee is resurfaced. Often, the medial compartment is most affected by wear-and-tear. So, if the remaining compartments of the knee are healthy, only this component will be replaced. When all three compartments are damaged, a total knee replacement is performed. The damaged cartilage is removed, and the implants are placed to restore the knees anatomy. With either a partial or total knee replacement, the goal is a well-aligned, stable and pain-free joint.
Advancements in knee replacement
To further enhance knee function after surgery, Dr. Assini is one of only a handful of surgeons using an innovative implant design called medial pivot. Unique to this implant is its ability to bend and pivot throughout a complete range of motion. “We often think that the knee is a hinge joint but it's actually more like a corkscrew,” Dr. Assini explains. “And so, if we if we want to be able to maintain that twisting function and keep it feeling normal and feeling stable, we use this implant that mimics the motion of a normal, healthy knee.”
The ACL and often the PCL are removed during a routine total knee replacement. These ligaments are needed to help drive the normal motion, known as kinematics of the knee. With the medial pivot design, the implant can replicate the function of the knees normal motion, and this leads to a knee that feels more natural for the patient and is more stable with day-to-day activities. Such a knee design is even more important in patients who want to return to skiing.
When placing a medial pivot or other implants, Dr. Assini and his team often can use minimally invasive techniques. These techniques allow the surgical team to operate through a smaller incision with less softer tissue dissection. Less dissection will lead to less inflammation and for patients; this can mean less blood loss, fewer complications, reduced pain, shorter hospital stays, diminished scarring and a faster return to normal activity. “We always want to use the least invasive surgery as possible, but we also need to make sure that the implant in placed in the most optimal position for the patient. This is why we employ other techniques to help us with the implant—such as computer navigation and patient-specific navigation. These add to our precision and accuracy in placement,” Dr. Assini details.
Proper recovery key to getting back on the slopes
While the surgical repair of the knee will allow you to stay active for years to come, Dr. Assini stresses the importance of recovery time after a knee replacement. There are three windows of time that Dr. Assini encourages patients to be mindful of during recovery:
- Weeks 0-2 are acute post-operative recovery. During this time, the goal is decrease swelling, get the knee moving and allow the incision to heal.
- Weeks 2-6 are the crux of therapy. This is the point where motion is getting back to normal and you wean off gait aides, such as crutches.
- Weeks 6-12 are dedicated to activity rehabilitation. This is the time when you can start to hike more, bike more and build up the strength to return to skiing.
After the 12-week mark, Dr. Assini states that those who previously skied can look at getting back on the slopes. “I don’t recommend that people learn to ski after a knee replacement, but if you already were a decent skier, you can get back into it carefully,” he cautions. “There’s a good chance that you can get back to where you were, but I’d recommend being sensible while skiing. Avoid things like moguls and look for those nice, well-groomed runs.”
Considerations for active knee replacement patients
Whether you’d like to ski after a knee replacement or not, it’s important to consider how to keep your new knee healthy. Dr. Assini recommends:
- Avoiding high impact activities
- Maintaining a healthy body weight
- Keeping your knees strong and mobile
- Remaining flexible and strong in your legs
- Being mindful of what hurts: pain is the body’s way of telling you something is not quite right
“We understand that being active is important to many of our patients and we want to help them get back to the level of activity they enjoy.” Dr. Assini reassures. “If you are experiencing ongoing knee pain, make an appointment with us so we can discuss your options and the best ways to allow you to enjoy many more bluebird days to come.”
Learn more about knee replacement at Swedish Medical Center.
Joseph Assini, MD is a board-certified, fellowship-trained orthopedic surgeon specializing in adult hip and knee replacement, complex joint reconstruction and general orthopedic trauma. Dr. Assini is committed to innovation to help get patients back to healthy activity, faster. One of his major areas of interest is in Rapid Recovery Total Joint Arthroplasty. Through this, most Dr. Assini's patients will leave the hospital the same day as their surgery. Committed to innovation and excellence, Dr. Assini is active in research and is currently participating in multiple clinical studies evaluating implant designs and new techniques to improve patient care. He is a developer of the AnteriorPATH technique for total hip arthroplasty, which is a novel procedure to enhance the recovery of patients undergoing total hip arthroplasty. At present, he is the highest volume user of this procedure in the Western United States. He also has designed a new implant for total hip arthroplasty that is utilized throughout North America and Europe.
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