Give up skiing? Not so fast

Replacement body parts no longer so limiting

By Tony Chamberlain
Globe Correspondent / February 10, 2011

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Five decades ago, Bruce Alemian was blazing out of the Thayer Academy backfield, the kind of runner linebackers were not anxious to take on. He was fast, shifty, and rough, and took his talents to Bowdoin.

He also played baseball and basketball, and, after team sports ended, a lifetime of singles tennis. One winter, inevitably, he found and fell in love with Alpine skiing.

After the decades spent playing these sports, coupled with his devotion to gardening and somewhat unusual hobby of building stout stone walls around his Hanover home, almost no one was surprised when Alemian, a retired corporate financial consultant, arrived at middle age with a bad hip and two worn-out knees.

These days, of course, such breakdowns are a commonplace medical fix, and Alemian came through the surgery with flying colors, all the limping and soreness that had plagued him gone. And, he reasoned with sadness, so was skiing.

“I just figured it was a part of my life that I loved, but was just over,’’ he said.

As a substitute, he and his wife Claire took to snowshoeing in the woods near mountains where they had skied. And one day, another inevitability.

“We finished a couple of hours of snowshoeing and decided to swing over to Killington just to get a cup of coffee and watch the skiers,’’ Alemian said. “We always enjoyed the mountain experience. So we were probably there about 10 minutes when I said, ‘You know, I’ve just got to see if I can do this again,’ ’’

But Alemian’s newfound enthusiasm was met with skepticism by his surgeon at Massachusetts General Hospital. What if he took a fall? Had a collision? Hooked a tip that might twist or torque his knee?

“Of course you think about those things,’’ said Alemian, who began skiing on some easy trails at Sunapee about four years after his last surgery, then returned to his beloved Sugarloaf, “but the reality is you just have to be careful.’’

As body part replacement becomes commonplace to an aging generation, doctors and physical therapists are moving away from the automatic opposition to strenuous exercise for patients who might not listen to the advice anyway.

But these days, the medical opinion seems to be shifting away from outright disapproval.

“What I tell my patients with total hip and total knee replacement is if you’ve never skied, or you’re a lousy skier, it’s probably not a good thing to try to pick up or necessarily improve,’’ said Dr. Thomas Thornhill, chairman of orthopedic surgery at Brigham and Women’s Hospital. “If you’re a good skier, or you don’t feel you have to ski moguls or in icy conditions — in other words you’re going to cruise the blues — that’s perfectly all right.’’

Thornhill, who skis and plays tennis, said much has changed since the early days of joint replacement.

“I think today with shaped skis that are easier to turn you stay in better control,’’ he said. “The skis are shorter, and that’s easier on the joints. People who skied in the old days probably had to be better. Now I think more people can rely more on their equipment than their talent. So it’s easier for people to ski in control these days, and that’s fine.’’

And yet there were the pioneers. One of Thornhill’s patients is Dr. Eli Factor, a Brockton dentist who had two hip replacements in his mid-60s and wondered about his future in skiing. Now 80, Factor, who skied until last year, remembers that generally the medical profession advised against Alpine skiing for hip and knee replacement recipients.

“Most of medicine absolutely said no, but [Dr. Thornhill] said, ‘Well, if you stay off ice and moguls, and you’re in good shape, go ahead and try it,’ ’’ said Factor.

Not only did he try it and spend the next 25 years at the sport, Factor was so enthusiastic he founded the “Steel Hipsters Ski Club of America’’ and sent out newsletters keeping members current on the state of replacement surgery as it applies to skiers.

“I skied as well as I did before the surgery,’’ said Factor. “I started with a group of people — some of whom had no medical approval. I skied very well. It is a good idea [when not skiing] to stay active, keep exercising, and have muscles in good shape.’’

At one point, Factor had the kind of scare that can begin some second thoughts flowing. After weeks of exercising to strengthen tissue around the hip caps, he experienced just the sort of common accident that happens to most people.

“Someone stepped on my skis and I fell backwards. I imagined that both of those hips were going to snap out,’’ he said. “It could even happen sitting in a very low chair. But nothing happened to me. I just stretched the ligaments. So, really, I’ve had no problems at all.’’

Though Thornhill recommends skiers with new parts reduce the stress on them by easing off the accelerator a bit, and choosing more forgiving conditions, there are some whose replacement surgery have not held them back at all.

Mick O’Gara was not just a competitive skier in his 50s, but one of the best racers for his age group in New Hampshire. A ski instructor at Waterville Valley, he is also on the board of examiners for the Professional Ski Instructors of America. The sport is huge in his life.

So when his right hip began giving him trouble, it was not a matter of standing without pain or walking better. O’Gara didn’t like losing the edge in his racing performance.

“I would find myself catching on my right side, and making softer [ski] turns to the right,’’ he said.

In May 2009, O’Gara underwent surgery, and eight months later put it to the test. That was the season he was the No. 1-ranked NASTAR skier for his age group in New Hampshire, and winner of the prestigious Hannes Schneider Memorial race.

But Bruce McDonald, head of the ski school at Wachusett Mountain in Princeton, a 68-year old who’s had two hip replacement surgeries and disc-fusion surgery, acknowledges slowing down on the slopes.

“I may not ski at the level I once did, but there’s a time when young skiers look for greater extremes to challenge themselves and stay interested in skiing,’’ he said. “Then there’s a time later in life when you’re going the other way, and just being out and enjoying it. We may not ski at the level we once did, but skiing is still skiing.’’

McDonald said when, in 1998, he realized hip surgery was in his future, he felt it important to find the right doctor.

“I wanted someone who had done this operation a couple of hundred times,’’ he said. He had surgery in June and was skiing in December.

But skiing after joint replacement surgery should carry a warning, said Dr. Scott Oliver, head of Plymouth Bay Orthopedic Surgery. “If you know how to ski, can balance and stay in control, that’s fine,’’ he said. “There are studies showing that high impact activities — such as basketball and running — lead to higher failure rate.

“So I think if people keep that in mind and take it easy while skiing, that’s OK. I would say if you have a hip or knee replacement and have never skied, this is not the time to take it up.’’