Downhill skiing is a popular sport globally and increasing number of patients undergoing total knee arthroplasty (TKA) seek to return to the sport. While skiing provides physical and psychological benefits, it also poses potential biomechanical risks such as torsional stress, high impact loading and possible implant compromise. Despite advances in implant design and rehabilitation, there is no consensus on the safety or functional outcomes of skiing following TKA. This systematic review aims to evaluate the current literature to assess postoperative outcomes, risks, and expert opinion on skiing after TKA.

A systematic review was conducted following PRISMA guidelines and registered prospectively with the PROSPERO database. Literature was searched in Medline, Embase, Cochrane, PubMed, and Scopus databases up to October 2025 using combinations of terms including “total knee arthroplasty,” “TKA,” “skiing,” and “winter sports.” Studies were included if they reported outcomes specific to skiing following TKA. Data was extracted on study type, sample size, follow-up duration, outcome measures and key findings.

From 572 identified studies, 21 were included. Most studies came from a single research group which conducted prospective cohort studies on post TKA skiing biomechanics, tendon morphology, and functional outcomes. Return to skiing rates following TKA was 47–51%. These studies found no increase in radiographic loosening or pain, and reported improvements in tendon stiffness, gait symmetry, and muscle strength after skiing. Patient-reported outcomes were favourable, with average Oxford Knee Scores >45 and Tegner activity levels indicating moderate to high activity. Survey studies showed mixed surgeon opinions, though most favoured a return to skiing for experienced patients with adequate strength and range of motion.

Current evidence supports that skiing after TKA can be safe and functionally beneficial for selected patients. Experienced skiers with good rehabilitation outcomes may return to the sport without increased risk of implant-related complications. Larger, long term and multicentre prospective studies are needed to provide definitive guidelines for patients and surgeons post operatively.