Resumption of sport after partial and full knee replacement: focus on skiing
Severe signs of wear and tear in the knee joint lead to knee joint arthrosis or gonarthrosis. This condition can lead to severe pain, restricted movement or a deterioration in quality of life. A certain degree of normality in everyday life and the ability to play sports can be restored with the implantation of a knee prosthesis, regardless of whether it is a partial prosthesis (unicondylar surface replacement) or a full prosthesis (bicondylar surface replacement). As these procedures are increasingly being performed on younger patients, the question often arises as to what expectations can be placed on a possible return to sport.
OVERVIEW
Knee prostheses for an active return to sport
The aim of implanting a unicondylar or bicondylar surface replacement is to eliminate pain, restore knee function and make sport and movement possible again. Full weight bearing is generally permitted immediately after the operation, provided the pain allows it.
In addition to freedom from pain, which used to be the primary goal of a knee prosthesis, maintaining or rather returning to sporting activity is at least as important for many patients. The prerequisites that make this possible are a precise surgical technique, an implant that meets the most modern requirements and is long-lasting, and the physiotherapy carried out after the operation. Of course, the patient’s previous sporting experience also plays a role. According to studies, previous experience is sometimes considered the most important prognostic indicator for returning to the desired sport.
Sporting variety also possible after knee prosthesis implantation
Cycling, swimming and golf are recommended by the Knee Society, the international knee society, but more demanding sports such as skiing are also possible with the necessary prior skills and appropriate post-operative training. The joint replacement itself should not be an absolute obstacle to high-impact sports such as tennis or the aforementioned skiing. Individual studies show that implants also tolerate a high level of activity and that sporting activity is not necessarily associated with an increased probability of failure. According to another study, falls and injuries to patients with total or partial knee replacements while skiing are a rarity.
With the appropriate prior knowledge, high-impact sports such as judo or tennis can also be resumed at a high level.
Successful return to sport: positive study results
The general literature shows a strong correlation between pre- and postoperative activity levels, which either remain the same or improve slightly. The rate of return to sport after knee replacements varies between 60 and 90%. The “return to sports” time is similar for unicondylar and bicondylar surface replacements, especially with regard to low-impact sports, although studies describe a return time of around one week faster for the partial prosthesis.
Another large-scale study on return to sport after unicondylar resurfacing showed excellent functional results as reported by the patients, with just under 93% of all patients able to return to their previous sport 4 years after surgery, mostly at the same level. Studies on bicondylar surface replacements show similarly good results and a similarly high number of patients who are able to resume their sport as soon as possible after prosthetic treatment.
Sports put different levels of strain on the joints
Different types of sport lead to different stresses on the joints. The joint load is increased during sporting activity and therefore also when walking. When walking on level ground, forces act on up to three times the body weight; when walking downhill, forces act on up to six times the body weight. Maximum loads of up to ten times the body weight are described for alpine skiing. However, this must always be assessed on an individual basis, as an inexperienced athlete places a higher load on the joint than an experienced athlete.
Back on the slopes with a hip or knee prosthesis
The number of people who ski with an artificial joint without any problems has increased significantly. According to a recent study, around 70 percent of skiers can resume their beloved sport after a hip or knee prosthesis, and in most cases even at the same level. Slight pain, a certain fear of the injury and impaired balance can occur, but are rare. To prevent this, skiing should not be started too soon after the operation. It is also advisable to prepare well with strength, coordination and endurance training. Physical activity, including winter sports, is recommended to strengthen the bones and prevent possible loosening of the prosthesis.
New outlook in knee arthroplasty
Good function and a largely natural joint feeling, the so-called “fortotten knee”, are the declared aim when implanting a knee prosthesis. However, it is very difficult to completely replace the natural bone, even with the best joint replacement. Survival times and service lives are already very good nowadays with over 90% survival times after 10 years, but young patients in particular often have even higher demands and requirements for their knee arthroplasty treatment. In contrast to the hip joint, the anatomy of the knee joint is much more complex, which makes a prosthetic “imitation” much more difficult.
Modern knee arthroplasty deals intensively with these biomechanical parameters and offers a wide range of optimizations. Newer prosthesis models can already mimic the physiology of the normal knee joint more closely and accurately than was the case with older prostheses. The future of knee arthroplasty lies in the creation of more natural knee joints, which leads to greater patient satisfaction and ultimately to an improved joint.
In summary, there is a general consensus that patients canreturn tolow to moderate impact sports withalmost no restrictions after full or partial prostheses. It is possible to return to sports with medium and even higher exertion, but this is usually assessed on an individual basis and depends to a large extent on previous experience.
Patients with unicondylar resurfacing return to sport about a week earlier and more successfully, but further studies are needed to assess the long-term outcomes after the return of elite athletes.
Sport after the insertion of an endoprosthesis is generally possible and also sensible. There is little or no evidence that sport can have a negative effect on an arthroplasty when practiced sensibly in so-called “low-impact” sports, but with “high-impact” disciplines, the return to sport should be individualized and tailored to the patient. This should always be done in close consultation with your orthopaedic surgeon.