Michael Koscuk of Hazle Township had tried everything. Late-stage arthritis in both his knees had left little to no cartilage to cushion movement between bones. Treatments including cortisone shots and injections of gel into the joint hadn’t helped. “My knees hurt just a little at first,” Koscuk says. “But the pain got to be more and more.”
Orthopedic surgeon Peter Kozicky, MD, with LVPG Orthopedics and Sports Medicine–Health & Wellness Center, immediately saw on X-rays how severe the problem was. “His knees were bone on bone,” Kozicky says. “When you reach that stage, you can either learn to live with pain and deal with decreased function or undergo surgery.”
Koscuk chose surgery – on both knees at once. He knew that this unusual course of action would mean more postoperative pain and a more challenging recovery. “But I only wanted to go through it once and be done,” he says. “I thought if I had surgery on just one knee, I might not want to go through it with the other.”
Koscuk’s double surgery, known as bilateral total knee replacement, was performed by Kozicky on Oct. 3, 2016, at Lehigh Valley Hospital (LVH)–Hazleton. But a knee replacement’s success also depends on moving quickly to recovery and rehabilitation. “Ideally, you get on your feet the day of surgery,” Kozicky says. Doing so helps the joint regain function and protects against complications.
Koscuk faced challenges not only because he had two knees done but also because his body weight put a lot of pressure on the joints. “I weighed more than 300 pounds,” he says. “When you’re heavy like that, standing the first time after surgery is really hard.” Once he passed that milestone, he began to progress rapidly. “He had a slow start but made up for it,” Kozicky says. “He was determined.”
Therapists at the Gunderson Center for Inpatient Rehabilitation at LVH–Hazleton were ready to make the most of his determination. Kocsuk moved up to the center three days after surgery for a 13-day stay. “Our goal is to get people functioning with the highest level of independence using the least restrictive device,” says Jennifer Kaminsky, Gunderson Center program director.
Working at Rehab
At Gunderson, Koscuk spent three hours each day split evenly between physical therapy and occupational therapy. “Michael was so motivated, he didn’t want anyone doing anything for him,” Kaminsky says. “He pushed himself a lot.”
Walking became easier, and pain steadily diminished with each day. Still, Koscuk faced challenges. “The worst was being able to get up from sitting,” he says. Lack of activity before surgery due to pain had left leg muscles weak. “And it’s often more difficult for taller people like him to stand from a lower surface,” Kaminsky says.
In physical therapy, Koscuk performed exercises while lying, seated and standing to increase range of motion in his knees and strengthen his legs. Therapists also worked with him on gait, balance and taking stairs. In occupational therapy, Koscuk went through movements involved with activities of daily living such as getting out of bed, stepping into the shower and putting on socks and shoes.
Getting Better at Home
When Koscuk left the Gunderson Center, he continued to receive therapy at home for two weeks through Lehigh Valley Home Care–Hazleton. At-home therapists guided exercises, assessed incisions, monitored pain control and watched for infection. They also worked with Koscuk on daily activities as he actually encountered them in his home. Because the home is often different than the center, occupational therapist Erica Stash says occupational therapy focuses on activities of daily living. “You may have to sidestep into the bathroom with a walker or cross an uneven grass surface to reach the house,” Stash says. Koscuk’s home physical therapy focused on stretching and transitioning from a roller walker to a cane.
Koscuk continued receiving outpatient therapy at the Health & Wellness Center at Hazleton. “Normally we would continue physical therapy for eight to 12 weeks,” Kozicky says. “At six weeks, he was done. He did well.” Koscuk feels that way too. He now regularly goes for mall walks and has lost about 20 pounds. “The day after Thanksgiving, I walked into the Health & Wellness Center without a cane,” Koscuk says. “I didn’t need it. Things are 100 percent better.”