Q: My passion is ski touring, and ski mountaineering. I am older (61 years old), and have one knee getting worse (knee replacement in the next few years). I can’t run with my knee, and I can only ski in resorts for about three hours without pain, but I can tour with descents all day. My doc said stop doing squats in training, so I have to work around that. What is the best course to pursue for optimal ski touring/mountaineering training when you have knee issues?

A: I (Scott) will field this one, since I had a total knee replacement 3 years ago. I am 63 years old, and a life long athlete. For several years, the functionality of my knee was on a steep, downhill slide. No, running, no BC skiing, I could barely go down stairs without a lot of pain. I couldn’t even XC ski. Seven surgeries over 35 years (most at Steadman’s clinic) after a bad climbing accident in AK in ’78 kept me patched together and able to run, ski, climb till the final 5 years.

Since my new knee I am running 1-2 hours daily. I just ran the Tour de Mt Blanc circuit (same course as the race). I can ski as well or better then ever, and have no pain or other issues with that knee. I would not hesitate to recommend getting a replacement for anyone like us who wants to be active.

Every year you wait, you become weaker and older so that recovering your previous levels of strength and fitness will take longer. I wish I hadn’t tried to limp along those past three years. Until you have a functional knee again, you will not be able to put enough load on that leg simply to maintain—let alone build—strength. If you are a candidate for replacement, then I assume all other remedial surgery options have been exhausted or ruled out. What are you waiting for? If it is done well, you’ll be happy and pain-free with 95% of original knee function. I was riding my bike 30 miles a day within a week of the surgery, and skiing 6 months out. Go for it.