BronxCare Health System: Sophisticated Orthopaedic Solutions Using State-of-the-Art Robotic Technology

By Katy Mena-Berkley
Thursday, March 4, 2021

Orthopaedic surgeons at BronxCare Health System are experts in the latest robotic techniques for hip and knee replacements.

Thirteen years ago, Ira Kirschenbaum, MD, Chairman, Orthopaedics, BronxCare Health System, Bronx, New York, helped expand an orthopaedic program to serve the Bronx community.

“I was hired to significantly enhance services and implement state-of–the-art orthopaedic options, thereby firmly establishing our program as an Orthopaedic Center of Excellence,” Dr. Kirschenbaum states.

BronxCare’s Orthopaedic Program now sees more than 50,000 outpatient visitors and performs more than 2,000 major operations each year.

“This community deserves every innovative, successful and evidence-based treatment available, and that is what we provide,” Dr. Kirschenbaum says.

(L–R): Jonathan Robinson, MD, Attending Orthopaedic Surgeon and Joint Reconstruction Specialist, BronxCare Health System, and Michael Coburn, Practice Administrator, Orthopaedics

Building a Team of Experts

The recruitment of physicians specializing in the complete spectrum of joint replacement surgery was essential to the development and evolution of BronxCare’s Orthopaedic Program. In its nascent stages, the department had only a few orthopaedic surgeons on staff, a status that has changed dramatically over the years. Today, 14 orthopaedic surgeons are an integral part of the orthopaedic department.

“Our surgeons cover every major specialty except for orthopaedic oncology,” Dr. Kirschenbaum says. “This includes joint replacement, orthopaedic trauma and sports medicine.”

“Mako technology is something special that BronxCare Health System is able to offer in the Bronx, providing our community with a better perioperative experience.”
— Ronald Huang, MD, Attending Orthopaedic Surgeon and Clinical Fellowship Director of Joint Replacement and Adult Reconstruction, BronxCare Health System, Assistant Professor of Orthopaedic Surgery at Icahn School of Medicine at Mount Sinai

Ronald Huang, MD, Attending Orthopaedic Surgeon and Clinical Fellowship Director of Joint Replacement and Adult Reconstruction at BronxCare Health System, Assistant Professor of Orthopaedic Surgery at Icahn School of Medicine at Mount Sinai, reviewing X-rays of an upcoming Mako knee replacement patient.

A knee osteoarthritis X-ray showing massive deformity that is reconstructed to a normal knee replacement using the Mako robotic system

Dr. Robinson reviewing X-rays on an upcoming Mako knee replacement patient

The Acquisition of Game-Changing Technology

In early 2020, BronxCare acquired Mako, a robotic-arm assisted surgery tool for joint replacement. Produced by Stryker, Mako utilizes computer navigation and sophisticated technology that enables surgeons to operate with a heightened level of control.

“Because BronxCare was already using Stryker implants, known to be some of the highest quality options in the world, the decision to add Mako was an easy one,” Dr. Kirschenbaum states. Using this tool for joint replacement, cutting alignment is more accurate, and hip and knee replacements are more balanced, according to Dr. Kirschenbaum.

“To utilize Mako to its full capacity, you need an expert surgical staff, and our joint replacement surgeons — Dr. Ronald Huang and Dr. Jonathan Robinson — represent the highest quality in New York City,” Dr. Kirschenbaum states. “Having these two specialists is unique. They are extremely well-trained, have talented hands, are empathetic and fully understand the process of care, which translates into being the backbone of our program.”

Additionally, Dr. Kirschenbaum notes, every major study indicates that surgeons who receive specialized training in joint replacement obtain better results than those who lack that additional experience.

“We are surgeons to a community of more than 1 million people. This population is bigger than that of some states in this country. Over the last decade, we have been here to serve them and will continue to be here, looking for the best technologies, methods and approaches that will provide optimal outcomes.”
— Ira Kirschenbaum, MD, Chairman, Department of Orthopaedics, BronxCare Health System

Ira Kirschenbaum, MD, Chairman, Department of Orthopaedics at BronxCare Health System (L), with (L–R) Dr. Huang and Dr. Robinson

Meet Our Surgeons

Ira Kirschenbaum, MD, Chairman, Orthopaedics, BronxCare Health System

A graduate of Albert Einstein College of Medicine in the Bronx, Dr. Kirschenbaum completed his orthopaedic surgery residency at Albert Einstein – Montefiore Medical Center. He received additional training at Rothman Orthopaedic Institute, Pennsylvania Hospital and Thomas Jefferson University in Philadelphia, Pennsylvania, where he completed a fellowship focused on hip and knee replacement and reconstructive surgery. Dr. Kirschenbaum’s resumé prior to joining BronxCare HealthSystem includes his position as the Chief of Adult Reconstructive Surgery for the Kaiser Permanente System and managing partner for an extensive multispecialty group.

Ronald Huang, MD, Attending Orthopaedic Surgeon and Clinical Fellowship Director of Joint Replacement and Adult Reconstruction, BronxCare Health System, and Assistant Professor of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai

A graduate of Sidney Kimmel Medical College, Dr. Huang completed his residency in orthopaedic surgery at Thomas Jefferson University in Philadelphia, Pennsylvania, where he was also Chief Resident. He completed a fellowship in adult reconstructive surgery at the Hospital for Special Surgery in New York, New York, and has authored multiple scientific papers on a range of medical topics, including aspirin therapy to prevent pulmonary embolism prophylaxis after arthroplasty, periprosthetic joint infection, and the effect of malnutrition on patients who are undergoing elective joint arthroplasty.

Jonathan Robinson, MD, Attending Orthopaedic Surgeon and Joint Reconstruction Specialist, BronxCare Health System

A graduate of Ross University School of Medicine in Bridgetown, Barbados, Dr. Robinson completed his residency in general surgery at the University of Pennsylvania Health System in Philadelphia, Pennsylvania, and his orthopaedic surgery residency at Icahn School of Medicine at Mount Sinai. Dr. Robinson also completed a postdoctoral fellowship in joint reconstruction at Lenox Hill Hospital and fellowships in joint preservation and resurfacing and replacement at Washington University – Barnes-Jewish Hospital in St. Louis, Missouri. Dr. Robinson became acquainted with Mako surgery for joint replacement in late 2012 while working in a research position.

Dedicated to Quality

Ronald Huang, MD, Assistant Professor of Orthopaedic Surgery at Icahn School of Medicine at Mount Sinai, Attending Orthopaedic Surgeon and Clinical Fellowship Director of Joint Replacement and Adult Reconstruction at BronxCare, and Jonathan Robinson, MD, Attending Orthopaedic Surgeon and Joint Reconstruction Specialist at BronxCare, are committed to delivering outstanding joint replacement solutions to patients using Mako.

“Mako is another tool in our toolbox that we can use to perform surgeries, such as hip and knee replacement,” Dr. Robinson says. “This tool makes surgery more consistent and lets us plan the more complex cases that we see in our practices. Using Mako, we are able to do these surgeries with very little bone loss and more consistent implant placement.”

That precision is made possible by a variety of factors, including a preoperative CT scan that allows surgeons to plan out their cases prior to using the computer navigation capabilities of Mako. Using that templating software, surgeons can place implants exactly where they need to be while sparing the maximum amount of bone possible. This precision can result in better patient outcomes in the long term.

“Normally, when we make bony cuts like a tibia cut, we would use an external cutting guide that wraps around the ankle and proximal tibia,” Dr. Robinson says. “Sometimes setting up that guide is perfect, but sometimes it throws things off a bit. However, with Mako, it can be perfect. Implant precision and bony cuts are where this robot truly excels.”

Postoperatively, patients undergoing robotic surgery in comparison to traditional hip replacement surgery may enjoy a decreased length of stay in the hospital, better early function and a reduced need for narcotics to manage pain.

“Mako allows us to have good outcomes that can be reproduced,” Dr. Huang says. “We can eliminate inconsistencies where patients previously may have had poor outcomes.”

“BronxCare is the only institution in our geographic area that invested in this modern technology in the best interest of the patient.”
— Ira Kirschenbaum, MD, Chairman, Department of Orthopaedics, BronxCare Health System

Dr. Huang and Tamika Negron, Lead Joint Replacement Surgical Coordinator

Dr. Robinson, Joint Replacement Specialist, is fellowship trained at Washington University and the International Muller Fellowship in Joint Preservation and Replacement.

A Collaboration of Excellence: BronxCare Health System and North American Partners in Anesthesia

Essential to a safe and comfortable surgical experience, anesthesia must be delivered with each patient’s unique needs in mind. That is why BronxCare has collaborated with North American Partners in Anesthesia (NAPA). NAPA is the largest single-specialty anesthesia and perioperative management company in the United States. NAPA offers BronxCare enhanced anesthesia care and anesthesia management services. According to Dave Livingstone, MD, Chairman, Anesthesiology, BronxCare Health System, “NAPA is laser-focused on patient safety and outcomes.”

“NAPA also shares BronxCare’s dedication to delivering health care that is cost-effective and efficient, resulting in the most favorable perioperative outcomes,” Dr. Kirschenbaum states.

Additionally, the Anesthesia Services team delivers a variety of regional anesthesia techniques and pain management solutions to treat and manage acute perioperative pain. This can be particularly beneficial for orthopaedic patients who have undergone total joint replacement. By delivering sophisticated ultrasound-guided peripheral nerve block options, patients experience reduced pain and an overall more satisfying experience.

“We have a deep appreciation for and commitment to the entire episode of surgical care,” says Dr. Kirschenbaum. “We seek to prepare each patient properly for surgery, are committed to excellence in the operating room, and pay close attention to detail after surgery.”

Advanced Options for a Unique Community

The 15th Congressional District, where BronxCare Health is located, is among the poorest in the United States. As such, it is not uncommon for its residents to let medical complications, including orthopaedic conditions, remain unchecked for significant periods of time, according to Dr. Huang.

“This population is unique in that patients have severe hip and knee problems, including deformities, because of their lack of education where health is concerned. They come to see us, often in later stages, to manage severe diseases that were not treated earlier,” Dr. Huang says. “We see severe deformities, which becomes the perfect scenario to use Mako technology. With Mako technology, we are able to offer something truly special.”

Dr. Huang notes that advanced orthopaedic deformities and diseases are more difficult to treat manually, and that is where Mako provides the most significant benefit.

While some patients have reservations about having robotics involved with surgery, a BronxCare’s Orthopaedic team is careful to inform them that the surgeon is in complete command of procedures when utilizing Mako.

“Some people may think that robotic technology like Mako replaces surgical decisions,” Dr. Huang says. “But I explain to my patients that it is just an extra tool to help us make small and precise adjustments and that these adjustments can make a positive difference in outcomes.”

Dr. Huang, Joint Replacement Specialist, is fellowship trained at The Hospital for Special Surgery.

Specialized Care for a Variety of Orthopaedic Conditions

BronxCare’s team of orthopaedic specialists provides a robust spectrum of options to manage orthopaedic conditions.

Hip and knee replacement surgery — Led by Ronald Huang, MD, Attending Orthopaedic Surgeon and Clinical Fellowship Director of Joint Replacement and Adult Reconstruction, BronxCare Health System, and Assistant Professor of Orthopaedic Surgery at Icahn School of Medicine at Mount Sinai, this area of care offers a thorough evaluation of diseases and deformities affecting orthopaedic health. Care includes close monitoring during surgery and a meticulous postoperative follow-up regimen. The joint replacement specialists adhere to a nationally recognized comprehensive episode of care program designed to enhance recovery after joint replacement.

Back pain and spine surgery — BronxCare’s spine surgeons work together with nonsurgical specialists to provide patients with a comprehensive offering of options to manage neck and back pain and deformities of the spine. In the event that back therapy, pain management options and spinal injections are not sufficient to adequately address a patient’s unique condition, the nonsurgical providers will refer to BronxCare’s orthopaedic surgical team. Led by Joshua Auerbach, MD, Chief of Spine Surgery, this group has access to advanced equipment and a modern spine operating room.

Hand surgery — Led by Sepideh Baghian, MD, Vice Chair/Chief of Hand Surgery, BronxCare Health System, the hand surgery team is trained and experienced in diagnosing and treating orthopaedic issues affecting the hands. Together with hand specialist Fillip Findling, DO, the hand surgery group addresses a wealth of issues, including arthritis-related complications, carpal tunnel syndrome, hand and ligament injuries, and infections. Additionally, the hand specialists address fractures of the elbow, forearm and wrist. Hand-related complications are the most common orthopaedic conditions seen by clinicians in BronxCare’s Emergency Room.

Sports medicine — Deborah Allen, MD, recognized as one of the premier sports trauma surgeons in the New York metropolitan area, leads the Sports Medicine Division at BronxCare. Together with her team of specialists, Dr. Allen strives to provide care that will help athletes overcome injuries so that they will be at peak performance as quickly as possible. The Sports Medicine Division has also expanded to include the “Game Day Same Day” program. This sports injury service was designed by Dr. Kirschenbaum, and it is available to athletic directors and amateur and school team officials, as well as to athletes directly. The goal of “Game Day Same Day” is to offer colleges, high schools and universities the kind of sports medicine options typically reserved for professional athletes.

Foot surgery — Under the direction of Co-Directors Joanna Ayoub, MD, and David Wong, MD, foot surgeons and podiatrists at BronxCare are providing comprehensive foot care to the community. Together, the team addresses early and late-stage complications of the foot, offering reconstructive foot surgery when necessary and also treating diabetic foot conditions, such as calluses and ulcers.

Outpatient Orthopaedics — Fellowship-trained Hand and General Orthopaedic Surgeon Ashok Dubey, MD, Director of Outpatient Orthopaedics at BronxCare Health System, leads this program, which is focused on optimizing patient care through nonsurgical orthopaedic treatment options. Danielle Scher, MD, a former military surgeon and Major in the United States Army, works together with Dr. Dubey to provide primary and musculoskeletal care to the community.

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