Dr. Kas­pa­rek, you are both a pro­sthe­sis spe­cia­list and a ski in­s­truc­tor. Do you ge­ne­rally con­sider win­ter sports with a knee or hip re­pla­ce­ment to be pos­si­ble – or ra­ther risky? 

I see win­ter sports af­ter knee or hip re­pla­ce­ment as a cle­arly rea­li­stic pos­si­bi­lity — un­der cer­tain con­di­ti­ons. Sta­ble mus­cles and re­asonable pre­pa­ra­tion are im­portant. With mo­de­rate stress and ad­apted tech­ni­que, many af­fec­ted peo­ple – per­haps not quite at com­pe­ti­tion le­vel as be­fore, but cer­tainly with joy and safety – can be active.

Many peo­ple are afraid af­ter the ope­ra­tion that they will never be able to ski or cross-coun­try ski again. How do you as­sess this concern? 

This con­cern is un­der­stan­da­ble, but of­ten exag­ge­ra­ted. Mo­dern en­do­pro­sthe­tics — with pre­cise im­plan­ta­tion and pro­tec­tion of mus­cles — al­lows very good mo­bi­lity and sta­bi­lity. If the he­al­ing is suc­cessful, the re­ha­bi­li­ta­tion has gone well and there are no other risk fac­tors — then there are many pa­ti­ents who are quite sui­ta­ble for ski­ing or tou­ring. Rea­li­stic ex­pec­ta­tion is im­portant: Tech­ni­cally de­man­ding win­ter sports, such as steep slo­pes or very un­even ground, should ra­ther be as­ses­sed with caution.

Which win­ter sports do you think are most sui­ta­ble for pro­sthe­sis wea­rers — and which are less so?

In par­ti­cu­lar, joint-fri­endly va­ri­ants are a good choice: cross-coun­try ski­ing, snow­s­ho­e­ing, gentle piste tours in mo­de­rate ter­rain. Ice ska­ting is also pos­si­ble – but with li­mi­ta­ti­ons: Those who have al­re­ady stood safely on the ice, have a good ba­lance and move carefully can cer­tainly find joy in ice ska­ting again. I would ra­ther ad­vise against it for beg­in­ners or those with gait in­sta­bi­lity, as the risk of fal­ling is in­creased.
To­bog­ga­ning can also be an op­tion – but ra­ther in con­trol­led tracks with little gra­di­ent, not in steep, un­se­cu­red ter­rain. Im­portant is a sta­ble sit­ting po­si­tion, well-func­tio­ning bra­king tech­ni­que and the avo­id­ance of ab­rupt mo­ve­ments when get­ting on or off.
Ski­ing with con­trol­led slo­pes, mo­de­rate speed and ad­apted tech­ni­que is pos­si­ble — with good pre­pa­ra­tion. Risky are steep de­s­cents, rough slo­pes, jumps or very un­even ground — I ad­vise cau­tion or al­ter­na­ti­ves there.

When, in your opi­nion, can you get back on skis or cross-coun­try skates af­ter a knee or hip replacement?

That de­pends on se­ve­ral fac­tors: he­al­ing pro­cess, mus­cle buil­ding, joint sta­bi­lity and con­sul­ta­tion with the trea­ting doc­tor. As a rough gui­de­line: If the phy­sio­the­ra­pist as­ses­ses the knee or hip as sta­ble, is suf­fi­ci­ently built up mus­cu­larly and there is no pain — then a cau­tious re-entry is of­ten pos­si­ble. Ho­we­ver, I re­com­mend start­ing the first days in the snow with ea­sier tours, test­ing tech­ni­que and slowly in­cre­asing the load.

What ad­vice do you give to sporty pa­ti­ents who want to get back on the slo­pes as soon as possible?

Pa­ti­ence, good pre­pa­ra­tion and rea­li­stic as­sess­ment. Strong leg and core mus­cles, good ba­lance and coor­di­na­tion are im­portant — ide­ally via a tar­ge­ted trai­ning pro­gram be­fore the sea­son. Tech­ni­que is al­most more im­portant than strength: A clean pos­ture, clean ski­ing, con­scious knee and hip mo­ve­ment and avo­id­ance of ex­ces­sive ro­ta­tio­nal or com­pres­sive stress are crucial.

Are there cer­tain con­di­ti­ons on the slo­pes or du­ring win­ter sports where pro­sthe­sis wea­rers should be par­ti­cu­larly careful?

Yes — un­even or icy ground, heavy wet snow, breaka­ble crust, steep de­s­cents or ir­re­gu­lar ter­rain when tou­ring in­crease the risk. Even pro­lon­ged stress wi­t­hout breaks can be pro­ble­ma­tic. I re­com­mend pay­ing at­ten­tion to good equip­ment — firm, well-fit­ting ski or cross-coun­try ski boots, pos­si­bly stock-stan­ding sup­ports for ba­lance, and con­sciously choo­sing simple terrain.

How im­portant is phy­sio­the­ra­peu­tic af­ter­care and tar­ge­ted trai­ning be­fore re-en­te­ring win­ter sports?

Very im­portant — that is, in my view, one of the most un­de­re­sti­ma­ted pre­re­qui­si­tes. Mus­cle buil­ding (quad­ri­ceps, thigh mus­cles, core), ba­lance and coor­di­na­tion trai­ning, fa­mi­liar mo­ve­ment pat­terns and sta­ble joint gui­dance are cru­cial. I re­com­mend tar­ge­ted trai­ning over weeks, not just shortly be­fore the sea­son — this im­pro­ves safety and re­du­ces the risk of in­cor­rect loa­ding or avo­ida­ble overloads.

Have you per­so­nally ex­pe­ri­en­ced ca­ses where pa­ti­ents have suc­cessfully re­tur­ned to win­ter sports af­ter a prosthesis?

Yes, many. I par­ti­cu­larly re­mem­ber a pa­ti­ent who, af­ter a hip re­pla­ce­ment, en­joyed ski tours again with joy and safety af­ter ye­ars — with con­side­ra­tion, ad­apted tech­ni­que and clear plan­ning. Such mo­ments show me that en­do­pro­sthe­tics does not mean the end of sport­ing ac­ti­vity — but en­ables a new be­gin­ning with con­scious and mo­de­rate stress.

What do you say to peo­ple who are still un­sure – be­fore or af­ter the ope­ra­tion — and want win­ter sports?

I say: Talk ho­nestly about your goals, but also about your ex­pec­ta­ti­ons. A pro­sthe­sis can make many things pos­si­ble — but it also re­qui­res mindful­ness. With good plan­ning, rea­li­stic goals and pro­fes­sio­nal sup­port, win­ter sports can be­come part of your life again. It’s not about achie­ving per­for­mance like be­fore — but about re­gai­ning joy of life, mo­bi­lity and safety.

What mes­sage would you like to give at the end to ever­yone who is con­side­ring: Hip and knee pro­sthe­sis and win­ter sports – does that fit together?

It fits – with re­ason, pa­ti­ence and re­spect for the new joint. Those who are wil­ling to prepare, re­main rea­li­stic and lis­ten to their body have a good chance of fin­ding joy in win­ter, mo­ve­ment and sport again. With mo­dern pro­s­the­ses and ex­pert care, much is pos­si­ble – not im­me­dia­tely world cup le­vel again, but a ful­fil­led, ac­tive life.