Photo caption: Nick Bozzo, patient of Humber River Health and co-owner of Toronto’s SanRemo Bakery.
By: Dave Yasvinski
Nick Bozzo was just 15 years old when a motorcycle slammed into him as he was crossing the street. The force of the impact sent him flying 20 feet, and while his injuries healed, his body was never quite the same. The now 52-year-old co-owner of Toronto’s SanRemo Bakery has spent decades working through various forms of discomfort, juggling the physical strain of lower-back pain and sciatica with the demands of running a successful café.
After the pandemic, though, something changed. “I started experiencing really bad hip pain,” he says. “It went from zero to eight out of 10 – it was crazy.” Bozzo soon found his way to Humber River Health, where Dr. Sebastian Rodriguez‑Elizalde and his team were earning recognition for their use of precision robotics, opioid‑sparing anaesthesia and an ultra- efficient surgical routine.
Over the past year and a half, Bozzo has had both hips replaced: the first with a traditional procedure and the second with the help of Humber’s recently acquired Mako Robotic Arm Assisted Surgery System. The difference, after both surgeries, was immediate. Bozzo was up and walking the same day, and within weeks, the pain that had ruled his life for years was gone. “It has been night and day,” he says. “You can’t put a price on being able to walk without pain.”
Raising The Bar
In 2020, Humber advanced the standard for joint surgery in Canada when it became the first community-academic hospital in the country to adopt the ROSA Knee System. The computer-guided robotic arm captures a real‑time, three‑dimensional view of a patient’s knee and guides every instrument stroke down to a fraction of a millimetre.
“It’s changed how we do knee replacements, because we get so much more information while operating,” Dr. Rodriguez‑Elizalde explains. “That degree of detail allows us to customize surgery to the individual.”
Anaesthetic protocols are a key part of the process Humber uses in conjunction with its joint surgeries. Instead of deep general anaesthesia, specialists use fast‑fading spinal and continuous nerve blocks that bathe the joint in local anaesthetic for 48 to 72 hours. This approach supports faster recovery and can dramatically reduce the need for post-op opioids – a key benefit for many patients.
“We’re prescribing about 10 per cent of the provincial average for narcotics after a knee replacement,” Dr. Rodriguez-Elizalde says. “That’s huge.”
Rewriting The Surgical Playbook
Roughly a year after ROSA arrived, Humber adopted Intellijoint HIP, a Canadian-made navigation tool that's like a GPS for hip replacements. During surgery, two coin‑sized trackers are temporarily fixed to the pelvis and thigh; an overhead camera reads their positions and instantly projects cup angle, rotation and leg‑length data onto a monitor, letting the surgeon set the new cup and stem with extreme precision.
Dr. Rodriguez Elizalde says this increased accuracy means more precise surgeries with fewer complications. These robotic surgery successes set the stage for Humber’s newest arrival, the Mako System. Unlike ROSA’s real-time imaging, the Mako uses preoperative CT scans to create a 3D model the surgeon maps out during the procedure. That preplanning allows for surgeries that are tissue-sparing and even more precise. While both of his hip surgeries were successful, Bozzo says it felt like he healed more quickly after his second, Mako-assisted procedure.
“That same week, I was able to do way more,” he says. “And you can barely even see the incision. It’s incredible.”
All that cutting‑edge hardware is only as good as the people who wield it, so Humber is also investing in technology that helps keep its staff sharp. This includes PrecisionOS, a virtual reality training module that lets surgeons, nurses and trainees walk through a surgery step by step to help them practise and perfect procedures.
A donor‑funded simulation centre is also in the works, adding a hands‑on space where the whole team can practise with real instruments before entering the operating room (OR). “It will allow us to host teams of surgeons to help them learn these new approaches for use in their own facilities,” Dr. Rodriguez-Elizalde says. “You can run six or seven different surgeries at the same time with a surgeon leading at the front.”
Less Waiting, More Living
Humber saw an opportunity to improve efficiency and make a dent in the provincial surgical wait‑list that had grown during the pandemic. According to Jhanvi Solanki, Vice President of Clinical Programs, the hospital convened a “war room” of surgeons, nurses and anaesthesiologists who timed every move in the OR, from opening instrument trays to wheeling patients into recovery.
The team managed to cut OR waste in half, shrink 15-minute set-ups to six minutes and pare down eight heavy surgical trays containing all the sterilized tools needed for a hip replacement to just three. Just as important, they decreased the average joint-replacement run time from over an hour to around 40 minutes. All those gains feed into a two‑room relay called Hyper-Throughput, where one patient is prepped while the previous patient is still in surgery. Moving back and forth between ORs, Dr. Rodriguez‑Elizalde was able to perform 14 knee replacements on the inaugural Hyper-Throughput Day in September 2023.
Since then, Drs. Barry Cayen and Justin Chang have also successfully adopted these workflows. Elements of this model are now embedded in day to-day operations, with every OR adding a case to help improve the hospital’s overall flow. Humber’s new approach has transformed what patients can expect from surgery, Solanki says. Streamlined procedures mean less time under anaesthesia, lower infection risk and earlier surgery dates – all of which help speed recovery and improve results.
“Hyper-Throughput allows us to repurpose the time that’s already in the system and use it to increase our capacity,” she says. It’s a big part of the reason Bozzo was able to have both his hips replaced much sooner than he expected.
Now, he’s making travel plans with his wife. “I thought it would be a year before my first surgery,” he says. “It ended up being a few months. We’re going to Dubai in the new year.”