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00:01One, two, three, whoa!
00:05Hello, mate. You understand Irish?
00:07Animals from all over the world
00:09Ah, bonjour.
00:11Come to see one extraordinary man
00:14who's known as the Bionic Vet.
00:16High five. Yes!
00:18Professor Noel Fitzpatrick.
00:21We only get one shot at this. Here we go.
00:23Noel and his team offer some of the most advanced treatments available anywhere.
00:28The perfect marriage of mechanics and biology.
00:30This is what we have now. A brand new knee.
00:33Oh, wow!
00:35For some, it's a last chance.
00:38It is a life or death situation because we cannot leave him like he is.
00:42I just want you to do anything you can for him, really.
00:45Sorry.
00:46As Noel continues to devise new ways of healing...
00:49You're going to be Bionic. Thank you so much.
00:52He transforms the lives of his patients.
00:55That is just unbelievable.
00:57He's raring to go.
00:58Against all the odds.
01:00Boom!
01:01One small step for a dog, one giant leap for mankind. Well done.
01:10Staff at Fitzpatrick referrals are no strangers to people who want to do their very best for their animals.
01:17Families will just go to extraordinary lengths for their pets.
01:20They are so dedicated.
01:23Some people, they'll travel massive distances just to try and get the best or the only treatment they can.
01:31Arriving today are devoted pet parents Rob and Mel.
01:36They've driven five hours from Cornwall with their six-month-old Bouvier de Flanders, Coa, who has a badly deformed front right leg.
01:45We have a dog that's broken.
01:47He's had growth problems on one leg and that's sending his foot out sideways and that's affecting his elbow and it's making one leg shorter than the other.
02:00He is everything to us.
02:03And I can't say much legs.
02:05I can feel my voice going and I should cry again.
02:10Mel and Rob live in Newquay where there are no less than 15 sandy beaches. Paradise for any dog walker, but them.
02:23We've always owned dogs.
02:26Come on, cuddle.
02:27We love Coa. He's our second Bouvier.
02:30Coa is great fun.
02:33He'd have his dinner and then he'd stand in his dish looking out the window.
02:38He is a fur baby.
02:40When I was grooming him one day I thought his leg didn't feel right.
02:46I got an old pair of tights and I've put them on his legs and you can really, really see that one is very bowed and one is very straight.
02:59Coa's in a lot of pain.
03:03He can't fetch.
03:05He can't run around.
03:06He can't jump.
03:07Coa can't be a puppy.
03:09Seeing Noel is his last chance.
03:18Noel has already assessed Coa and had scans and x-ray pictures taken of his leg.
03:24This poor dog has grown quite fast, which is the nature of this breed.
03:29Yeah.
03:30Therefore, deformity happens at an early age because these two bones grow at an absolute rate of knots.
03:37And if we look at the CT scans, you'll see there's a massive banana shape here.
03:43You've got a deformity which is forcing the foot in a completely different plane.
03:49Now, when something is curved, twisted and translated, then our life gets very, very difficult indeed from the correctional point of view.
04:00And it's because this bone stops growing and acts like a bow string and this one keeps growing and acts like a bow.
04:09It's actually quite rare to see one this bad.
04:12The wrist is probably like 90 degrees like a flipper.
04:15Oh, my God.
04:16The other problem, of course, is that one leg is dramatically shorter than the other and getting worse every day.
04:23The options are continual medical management I did not feel was a good option.
04:28No, not fair.
04:29Taking the leg off is absolutely an option or do major surgery.
04:34But the surgical procedure is complex as the leg not only needs to be straightened but also lengthened.
04:41All right, so if you think what I'm going to have to do, I'm going to have to cut it there to get that bit back to there.
04:48And I'm going to have to cut it here to get that bit back to there to somehow make that straight.
04:54Make it cut in the middle, rotate it a bit and then you want to grow in the middle.
04:59Right.
05:00Do you understand?
05:01Yeah.
05:02But legally I'm obliged to tell you before we do any surgery that euthanasia is an option.
05:07Yeah.
05:08If he was miserable and unhappy and not interested in life, completely different.
05:16I think we need to give him the option to have surgery to fix it.
05:27You need to understand that once we start down this road, we're in it together and we've made a collective decision and that we will pull the plug if he's suffering.
05:37We would never do it just for you.
05:39No.
05:40No.
05:41Never do it just for ourselves.
05:43Yeah.
05:44My deepest fear is that we go through all of this, all that technical detail, five months of a journey and then end up amputating the leg.
05:51My stomach is in knots.
05:53Yeah.
05:54We just need to try for him.
05:58Seven miles down the road is Knowles Guildford Hospital.
06:12The centre specialises in oncology and soft tissue surgery.
06:16Hey, sweetie.
06:17Arriving today is Patricia with her 11-year-old Rhodesian Ridgeback, Kwanda.
06:24That's right.
06:26We thought we had like a sleepy eye where the edge part was coming in, but actually it continued to come in and it got larger and larger and actually covers almost half of her eyeball.
06:39And now it seems to slightly bother her, as if she's realising that she's only got almost half of the sight in the one eye.
06:49Patricia lives in Chobham, Surrey, but Kwanda's not her only companion.
06:54I've got six dogs.
06:56They're my family, my kids.
06:59They are the whole of my life, actually.
07:02I've had Kwanda, so she popped out of her mother as a little puppy.
07:06Kwanda is my favourite because she's a very polite little girl, doesn't give offence to anybody.
07:12And she's a nice little girl.
07:15But last month, Patricia noticed the worrying swelling in Kwanda's eye.
07:21My vet thinks that it probably is cancer.
07:24Having had cancer myself, I know you can get through it.
07:28And if you catch it fast enough, as mine was, then you're on a winner.
07:35And even if she's only one-eyed, if I've got my nice, happy Kwanda back, then I shall be as happy as Larry.
07:44Kwanda will be examined by senior clinician Dr. Laurent Finji.
07:52Come on in.
07:53That's a good girl.
07:54Come in.
07:55Hello.
07:56Hello.
07:57Thank you again for fitting us in today.
07:59That's it.
08:00It's supersonic.
08:01Oh, don't worry.
08:02I'm not going to trouble you too much.
08:04Just having a quick look.
08:05That's it.
08:06All right.
08:07I can actually see the little bulging there.
08:16Okay.
08:17That's good.
08:18All right.
08:19So I think either it's infectious, like an abscess can happen, could be a tooth problem.
08:25It could also be a tumour.
08:28We have specialists in imaging here, so we'll see also if she has any obvious other problems.
08:32Yes.
08:33That's it.
08:34If you will for me, please.
08:35I brought her into the world, so I don't know that I want to lose her yet.
08:39Do your best.
08:40We'll do our best.
08:41But she's got to have a quality of life.
08:42That's the bottom line with mine.
08:44All right.
08:45All good.
08:47Talk to you soon.
08:48Oh, no.
08:49Thank you very much.
08:50All right.
08:51Let's go big girl.
08:52Good girl.
08:53Good girl.
08:54Look at that.
08:56Don't worry.
08:57Because she's special.
09:01She's the last of a line.
09:06So I hope.
09:07Yeah.
09:08No.
09:09It'll go well.
09:10It'll go well.
09:15Straight away, Laurent can see what's wrong.
09:20This is not looking like an abscess at all.
09:23It looks like it's a tumour.
09:26It's a bit disappointing that it's not an abscess.
09:28An abscess, obviously, is completely curable.
09:32Whereas this tumour, for the moment, we don't know if it is.
09:36The only way to find out how serious the tumour may be is to take a biopsy and send a sample to the lab for testing.
09:44So we submit that to our pathology lab.
09:48They will tell us.
09:49They will confirm that it's a tumour.
09:51And hopefully being able to tell us what type it is and how aggressive it is.
09:57Laurel updates Patricia.
09:59Are you ready for me?
10:00So this is the eye that's normal and it's in a normal position.
10:09Yes.
10:10And that's the eye that's been pushed out.
10:11And you see how much it's been pushed out.
10:13And it's been pushed out by this big thing here.
10:16You see where it's pushing a little bit in the mouth.
10:18Look at it.
10:19This is how the eye is pushed out.
10:20Really pushed out of place.
10:21Exactly.
10:22And just by this mass again.
10:23What I don't know is if we could spare the eye or not.
10:25If you see here, it's very much in contact with the eye.
10:28Yes.
10:29One, two, three.
10:32I've asked for the pathology results to come urgently.
10:36So it still needs time to be processed.
10:37It needs to be sent to the lab and processed.
10:39She'd be better off having an eye missing.
10:42Yes.
10:43But who knows if she sees very well in this eye at the moment anyway.
10:46Well, at the moment, the way it is, she's not happy.
10:48It might be easier for her to learn to do without it.
10:51Sometimes it's better to do without.
10:52So one step at a time.
10:53Yes.
10:54Let's wait for the results from pathology and we'll see from there.
10:56Results and just see.
10:57That's it, yes.
10:58Okay.
10:59Oh, here's my Quandah, you see.
11:01Here's my little old lady.
11:03Wait till you smell my car.
11:04It's got chicken in it.
11:05Nothing more can be done for Quandah
11:07until the results are back from the lab.
11:10The worst case scenario would be that she spends a long time in here
11:16with me not knowing whether or not I'm going to lose her.
11:19For me, cancer is the killer.
11:22So it's got to be removed and sorted.
11:30It's mid-afternoon.
11:32Mel and Rob are back to see Noel
11:34so that he can take a closer look at six-month-old Koha's bowing front right leg.
11:40So now you can see this three-dimensional deformity I'm talking about.
11:43That's the banana there at the back.
11:45You see that?
11:46Yeah.
11:47The radial carpal bone is here and it should be straight under the radius.
11:50See, even under that deep sedation it hurts.
11:53Oh, Jesus.
11:55Stay there.
11:56Yeah, good.
11:57All right.
11:58Wake him up.
11:59Let's go.
12:00Let's go.
12:02So straight up and down again now that the leg's shaved.
12:05That will help me out.
12:06Keep going.
12:07You're not with it, are you?
12:08Look, you're all calm now.
12:09Okay, we can see it now, can't we?
12:10Look at that.
12:11There's a compensation.
12:12The elbow's going out.
12:13The wrist is going in.
12:14It's a big deal, this.
12:15This is not a small undertaking.
12:17It's a massive big deal and we may fail.
12:20Koha's surgery will be complicated.
12:22Noel will need to create plastic 3D models and plan the operation very carefully.
12:29Looking at that leg, you think, Jesus, that is a mess.
12:34Some people will say, oh, just put him down.
12:37But you can't do that when there's a chance.
12:40I would regret it.
12:43Oh, kisses.
12:44Oh, bless her.
12:45It's Patrick with Ferris Orthopaedic Archaeology Natalie speaking, can I help?
13:04It's mid-morning and Jane has arrived with her son Ian and her seven-and-a-half-year-old
13:11aide, Cleo.
13:13Cleo has struggled with pain in her back leg for years and previous surgery has failed.
13:19She's had her right hip replaced twice, but that one's only lasted about a year and she's
13:26now very seriously lame.
13:28Right, Cleo's mummy, please, Cleo's mummy.
13:32What's the symptoms?
13:33It just...
13:34She's hopping and lame, seriously, you can see she's lame on both legs in actual fact,
13:40but the right one seems to be the worst.
13:42Right, let's have a look.
13:44Good girl.
13:45All right, good girl.
13:46Steady, steady.
13:47Steady, steady.
13:48She will go rigid with fear.
13:50She is painful, aren't she?
13:52I know she is.
13:53All right.
13:55Okay, all right.
13:56She's slobbering now.
13:58Yeah, well, because she's very brave, she's just slobbering when the pain happens,
14:03rather than, you know, being aggressive or anything else.
14:06She won't show you.
14:07Sure.
14:10Jane lives in Hampshire, surrounded by animals.
14:15My love of animals started from childhood, really.
14:18Well, we have three rescue dogs, four horses, and we encourage our wildlife here.
14:25Jane took Cleo in as a rescue dog when she was just a year old.
14:30We wanted to get another dog.
14:32We didn't go and look.
14:33We asked for a dog that might find it hard to get a place.
14:38They gave us Cleo.
14:40Cleo is a real live wire.
14:43I love her personality.
14:46If you like a dog that's lively and gives everything, you would like Cleo.
14:55But three years ago, Cleo developed hip problems, and she's still suffering.
15:01She's had two hip replacements, and this, sadly, over time, has gone wrong.
15:08I know that it's bad, but I don't know to what level it's bad.
15:14She just needs, just needs an operation so she can live a life.
15:21Just to see her run again and enjoy it would be lovely.
15:26If Noel's able to fix her, it would be tremendous.
15:31Noel has sent Cleo for a scan to get a better idea of the state of her hip and the current implant.
15:39Failed hip replacements can cause severe bone loss, affecting the hip socket and femur,
15:45which means repeated surgery becomes increasingly difficult.
15:50On the x-ray picture, you can see there's a bolus of cement around the cup,
15:54but you can see on the CT scan that there's a lucent line between the cement and the rest of the bone,
15:59meaning that that cement is moving in the bone. It's not bonded.
16:04In addition to that, the femur's in big trouble.
16:08This wall of the femur is crumbling.
16:14It's a hip replacement that has gone wrong.
16:17Very wrong. Yeah.
16:19She coped with all of that.
16:22Do you know, she's always been happy.
16:25The bottom line is that revision's very complex.
16:28Leaving her as she is is not a great option because there's a lot of pain.
16:31No, I know. No, I know.
16:32Taking off the leg is possible, obviously, and is an option,
16:36but the challenge is that the other hip is really bad.
16:39I know it is. So what would you do?
16:41Well, what I'm thinking is that we would have to put something there to shore it up.
16:47Now, whether we could put a partial half a femur in there
16:53and somehow screw it on to what's left of the outside.
17:00The socket side, I would engineer a revision cup for that somehow.
17:11And also, I'm morally bound to tell you that whatever I do could fail.
17:16I can't leave it as it is.
17:18And I just want it as strong as I can get it.
17:21Come on, bubba.
17:24Hello.
17:25Noel needs to create a bespoke implant to reconstruct Cleo's hip joint
17:29and reinforce her decaying bone.
17:32Amputation is an option, but she has arthritis in her other hip.
17:36There's the possibility of the leg being removed, but obviously I'd rather not
17:40because the other hip is not very good, but I don't want to lose her.
17:44So that would be the last option, really.
17:48But he's still thinking along the lines of being able to repair that one.
17:53Today, Mel and Rob have brought six-month-old puppy Koa back to Fitzpatrick's for her complex surgery.
18:10Koa is unable to run around like other puppies due to a deformed front right leg, which is also too short.
18:17The options we started off were not good, but we decided to give him the best bet we could do.
18:26I'm trying not to show that I'm very emotional about it and I could cry at any minute.
18:32Ultimately, if it doesn't go right, he'll lose his leg.
18:37Surgery is just the start for Koa. Once it's completed, Noel will begin the gradual process of lengthening his leg.
18:47Yeah, no worries. As this will take several weeks and he's so far from home, Koa will remain at the practice for daily monitoring.
18:55The surgery's a big deal, you know? Yeah.
18:58And it's quite a painful thing to do, so he's going to need to be on heavy-duty painkillers for the time being.
19:04Right. But he looks like he's looking forward to it.
19:08Well, I doubt that very much, but we will do our very, very, very best.
19:12All right, good. Let's go through, Laura. Let's go through. Big cuddles, Mum.
19:15OK. He doesn't want to cuddle. There you go. See you later, mate.
19:18All right, big fella. Please be good. Good boy. Please be good.
19:22Good boy. Right. I'll do my very best. Good.
19:25Mel and Rob will return to Cornwall, and because of the distance, they won't see Koa again until his treatment is complete.
19:34Am I?
19:35It's just scary not knowing it is, and it's going to be the longest day for a while, I think.
19:44This is the start of it, really. Very apprehensive, because anything could happen.
19:49Come on. Let's get the dog sitting up.
19:53Koa has been anaesthetised and clipped.
19:56We can see here how deformed the right front leg is by comparison with the left.
20:01There's a massive bow on it in all directions. This is going to be a massive challenge.
20:06To straighten Koa's leg, Noel will drill out the wrist cartilage, cut some of the tendons, and rotate the foot back into alignment with the elbow.
20:17Both forearm bones will be cut. Noel will rotate the twisted radius to make it straight.
20:24The forearm bones will then be secured to rings and wires to make a specialist expanding frame, which will gradually lengthen Koa's leg as it heals, a technique known as distraction osteogenesis.
20:37Finally, he will fuse the wrist solid in the correct position, using pins attached to the base of the frame.
20:45It's just before 8pm. Noel's already opened up Koa's forearm and cracked the short ulna bone that was causing the radius to bow.
20:56What we've done is we've removed the bowstring effect of the ulna.
21:00Next, Noel opens up the wrist.
21:04It should be exactly straight, but it's curving that way, pushing the foot that way. As a result, the wrist is deformed. Poor little fella.
21:13Noel drills out the cartilage from each wrist bone and cuts the tendon, which is stopping him pulling it back into alignment with the leg.
21:24The wrist is all floppy now. You can move around in any direction. We can pull the wrist back into a more or less straight alignment, as you can see.
21:32Noel then turns his attention to straightening Koa's forearm.
21:37So you have to cut it by drilling it and then splitting it. But you can't cut it with a saw. If you cut it with a saw, the heat will kill the cells.
21:44If the cells die, the bone won't be able to grow once it's been straightened.
21:50OK, so just crack the radius in half there. And you can now see that I can grab the elbow and the wrist and just rotate that right around like so.
22:00With the leg held straight, he attaches a frame with wires and rings that will hold the bone segments in the correct position.
22:12The frame will make the bones longer by gradually pulling the segments apart at the break points, which encourages new bone to grow between them.
22:22I'm going to make it grow by turning this dice here. Every time I turn from one to two, that pulls this apart one quarter of a millimetre.
22:33And we're going to make new bone right here, make this bone longer.
22:39Finally, Noel skewers the wrist with larger pins so it is straight, extends the frame to hold these pins in position and adds bone graft.
22:52And that should act as a scaffolding for the bone to grow in between the wrist and the radius.
22:58He stitches up Koha's leg and finally, after five hours, the operation is complete.
23:07Well done.
23:09Hi Melanie, it's Noel here.
23:11Hi Noel.
23:12As if anyone else would be ringing at 1am.
23:14Yeah, true.
23:15OK, so I've done the operation. As you might expect, it was very challenging.
23:20Is he comfortable now?
23:22He is zonked.
23:24Oh, I do.
23:26He's not going to know anything for the next 48 hours.
23:30Thank you for believing in him. He's a lovely chap.
23:32Thank you. Bye.
23:35Oh, man.
23:47It's a week since Kwanda the Ridgeback came to Noel's Guildford Hospital for tests on a lump behind her eye.
23:54And Patricia has had the results.
23:57It's a cancerous growth and it also goes all the way down in that bone socket to her jaw.
24:06I remember when they said it to me.
24:08I'm sorry to say, but you've got cancer.
24:10That's when it takes the wind out of your sail.
24:12And I found myself crying as if I was a two-year-old.
24:17Today, Patricia's also brought Kwanda's sister, Amira, as a potential blood donor.
24:24That's it.
24:25That's it.
24:30We're going to have to remove some bone.
24:32Yes.
24:33To access the tumour first.
24:34Yeah.
24:35So some of the cheekbone here, some of the upper jaw.
24:39The jaw.
24:40Maybe a little bit of the lower jaw as well.
24:41Okay.
24:42Regarding the eye, actually, if we find that we have any adhesions of the tumour that will compromise the function of the eye, then we might have to remove the eye.
24:51Yes.
24:52That's fine.
24:53All right.
24:54Are you going to stay with us?
24:55I'll see you soon.
24:56You'll be good.
24:57It's going to be all right.
24:59Perfect.
25:00Yeah.
25:03I think it's going to be a long day.
25:05Even when they tell me they start, I think I'm going to be looking at five to six hours before I hear it again.
25:11That's a whole day.
25:13It's going to be hard.
25:14Yeah, I'll leave you.
25:16You can actually see inside the mouth here that you have this little lump here as part of the tumour.
25:29This.
25:30So we're going to approach the tumour from the mouth to be able to do a cut here.
25:34And we're going to do another cut just under the eye here to be able to approach from the lateral aspect as well.
25:40So we'll have to remove some bone to access the tumour.
25:44Hopefully we can then resect the tumour and reconstruct.
25:48Laurent first needs to remove the lymph nodes in Kwanda's neck so they can be sent to pathology for testing to find out if the cancer has spread.
25:58There it is.
25:59Nice.
26:00Yeah, we're good.
26:01So you can see.
26:02It was big enough to actually try to hit me.
26:07He now needs to remove the tumour.
26:12We're going to make a much bigger smile, a kind of a joker smile.
26:18He cuts out part of the jaw and cuts into Kwanda's cheekbone.
26:23So all this is the tumour, this big bulge there.
26:27So that's good because that's the eye.
26:30And the tumour is not adherent to it.
26:33This means there is a greater chance that Laurent may be able to save Kwanda's eye.
26:38We'll have to be cautious not to have the eye drop in too much because there'll be such a hole.
26:44If the eye pops out, we'll put it back.
26:47Laurent begins to cut out the tumour.
26:50He needs to take it all out if he is to stand a chance of completely removing the cancer.
26:55That's it.
26:57That's the whole tumour.
27:00So far, so good.
27:05We have a pretty big hole in the mouth that's leading into the old bit there.
27:11This is where the tumour was.
27:13Not only has Laurent managed to remove all of the tumour, he's also managed to save Kwanda's right eye.
27:21He's now able to perform careful reconstruction surgery on her face.
27:26Look at that.
27:27The eye is back in position.
27:29Good.
27:30Hopefully she'll feel good.
27:31She should see better.
27:32But hopefully she'll soon, well, be back to being completely normal.
27:37Kwanda will need to recover from surgery and await the results of the lymph nodes test to see if the cancer has spread.
27:53Oh, lovely.
28:00Hi, Frank.
28:03My doggie's name, but he's a bit bigger than you.
28:08Take a seat.
28:11Thank you, Frank.
28:12It's midday and Jane is back with Cleo the rescue dog.
28:18Today, Cleo is having surgery to replace her failed right hip implant.
28:23But her hip is in such a bad way, success is far from guaranteed.
28:28I know that she could lose her leg.
28:31And when you've put her through it two other occasions, it is worrying.
28:38It really is worrying.
28:40I know it's got to be done.
28:43I'm worried.
28:44Jane has brought her eldest son, Simon, in for support.
28:58Simon, nice to meet you.
28:59Hello, how are you?
29:00Hello.
29:01How are you again?
29:02Fine, thank you.
29:03All good.
29:04Because of Cleo's crumbling hip joint, Noel has had to design a groundbreaking custom implant.
29:09So, I've made a mesh out of trabecular metal, which is like a half a barrel.
29:16And that half barrel was going to go in that position there.
29:22Down the side of the bone, we're going to put this very complex plate.
29:27So, this is going to go up over the top of that.
29:31So, that takes the load from that piece of exposed bone all the way down to solid bone, down to here.
29:37You see, it's quite a complex, but hopefully quite a robust construct.
29:42Yeah.
29:43So, the potential complications are, I go in and the bone is mush and I have an awful time.
29:50But I've made every possible plan I can to try and avoid that and to try and save the leg.
29:56All right, Cleo, you come with me, sweetheart.
29:59Yeah.
30:00We're going to go and see all the girls.
30:03All right.
30:04I'll call you tonight.
30:05Come on, Cleo.
30:06We're going to play games.
30:07Yeah.
30:08See you later, guys.
30:09See you.
30:10Bye.
30:12I don't want to lose that leg.
30:13No, that's what I'm really worried about, I think.
30:15I don't want her to lose that leg.
30:17It's a horrible feeling, really, because I've been wanting this day so much, but dreading
30:23it at the same time, because I don't want to leave her.
30:26I just want her to be well, because she is a really nice dog.
30:32Cleo is taken into theatre.
30:36Noel begins by opening up her leg, revealing the condition of her hip and current implant.
30:42Oh, man, it's a freaking mess.
30:47So we can see here where there's a big area of bone that is eroded.
30:52You can see the stem sticking out with no bone on it.
30:55To remove the old stem, Noel needs to slice along the length of the femur and take a section
31:01out of the side like a lid.
31:04But there's a risk it could fracture.
31:11Don't be very careful now.
31:14Don't twist, don't twist.
31:15We'll have a fractured femur in a heartbeat.
31:17Do not twist.
31:19Don't move.
31:21I'm just popping the lid off now.
31:24OK, we're going to try and bash the stem out now.
31:27We'll see what happens.
31:28We've got to be very careful we don't fracture the femur.
31:30OK, it looks like it's coming out, so that's good.
31:33There's the stem.
31:40Noel now needs to remove the cement from the previous two failed hip replacements.
31:46As soon as I take this cement out here, this is all going to crumble.
31:53So super, super duper careful.
31:59Be very careful, we've got a piece breaking off here.
32:01Let go, let go.
32:03So it's very important we get all the cement out because the cement can act as a focus for infection.
32:12With the old cement successfully removed, a bespoke plate is attached to the femur to prevent fracture of the weakened bone.
32:20We're going to put the bone lid back on, like so.
32:25A specially coated half barrel attached with lasso wires is used to fill the defect in the femur and encourage bone growth.
32:33You can see the grooves along here hold the wire and that wire holds on this half barrel.
32:40Fresh cement is pumped inside the femur and a new stem is inserted.
32:50Noel then focuses on adding a new bespoke hip socket.
32:55This is the cup that we're going to bolt onto the side of the pelvis.
32:58It's got five screw holes in it that we're going to bolt onto the side of the ileum.
33:02And it's got mesh in the back into which we can get bone to grow.
33:05With the metal cup anchored in place, Noel cements a plastic liner inside it.
33:11He then attaches a metal ball to the stem.
33:14It's then pushed into the cup, forming a new hip joint.
33:18So we can see the new cup and head now.
33:20We can see it all moving in place.
33:23And hopefully the pelvic bone will grow onto this cup permanently.
33:35Okay, done.
33:49Cup looks good.
33:53Well, we've done our best.
34:05Oh, you little monkey, do you want to grow? Can I have a gravy bone?
34:12So handsome.
34:14Hello. Come on then. Come on, Michael.
34:19Oh, such a good boy.
34:22It's been five days since Koa had surgery on his deformed leg.
34:27The leg is too short, so using a technique known as distraction osteogenesis,
34:33Noel will grow the bone an extra seven centimetres while it heals.
34:38There's two factors that come into play when we're making bone grow.
34:43One is rate and one is rhythm.
34:46Rate is the rate at which you turn the dice.
34:49So if you turn it, for example, one millimetre a day,
34:52one and a half millimetres a day or two millimetres a day, that's the rate.
34:55The rhythm is the number of times you do it per day.
35:01And all of that is based on experience.
35:08So ideally, I would like to turn a half a millimetre four times a day.
35:17We're now going to start turning the dice.
35:20Two, three, four.
35:25Always remember to turn toward the right with this frame.
35:29You got it?
35:30Yeah.
35:34It will take six more weeks to fully lengthen Koa's leg.
35:38At Noel's Guildford Hospital, 11-year-old Quanda is recovering from her surgery to remove a cancerous tumour from behind her eye.
35:50Hello, gorgeous.
35:51Good girl.
35:52Good girl, Quanda.
35:53Your face is a bit swollen, isn't it, Quanda?
35:56Today, Patricia has been called in to find out whether or not the cancer has spread, and if she's finally able to take Quanda home.
36:08She's been here a long time. I'm actually excited about seeing her. I need my special girl back, please.
36:15All right. So, Quanda's doing really well.
36:18Good.
36:19We've had the results from pathology.
36:20Yes.
36:21And they're good.
36:22Ah.
36:23The tumour, it's a low-grade one.
36:24Good.
36:25So, very unlikely to have spread.
36:27Just going to finish by that.
36:28Her face swole quite a bit after surgery.
36:30Yes.
36:31It's just slowly reducing.
36:33She has a little bit of her upper jaw missing here.
36:36Inside.
36:37Yeah.
36:38But you won't see anything.
36:39Okay.
36:40So, I'll go get her now, okay?
36:41Yes, please.
36:42All right.
36:44Hey.
36:45Quanda.
36:46Hey.
36:47Pretty, pretty, pretty, pretty, pretty.
36:48Oh.
36:49Oh.
36:50I've got a nice harness for you, too.
36:53Oh.
36:54So, let's have a look at you, pretty girl.
36:56Oh, it's neat and tidy.
36:58Now you've done a lovely job.
37:00Good try.
37:01Good try.
37:02Oh, no.
37:03She's gorgeous.
37:04And you've still got your eye, and that was my worry.
37:06Thank you very, very much.
37:08You're very welcome.
37:09I'm sorry.
37:10The greatest thing, yes.
37:12I've got her back.
37:13And she looks good.
37:14And she's happy.
37:15She wasn't as bad as I thought she was going to be.
37:17It was like looking at a different dog with a different side of the face, but it wasn't
37:21nearly as swollen, and the eyes moving beautifully.
37:24And I'm sure she's very pleased to be going home.
37:27Although the cancer is unlikely to spread, Gwanda will be back for check-ups, just to make sure.
37:37Two days ago, Cleo the rescue dog had complex revision surgery on her right hip.
37:43Jane's back to find out if she's well enough to go home.
37:46Now, Cleo's mummy.
37:49How are you today?
37:50I'm getting fine.
37:52Uh, Cleo's doing fine.
37:55We're going to require quite a lot of rehab.
37:57But that's okay.
37:58If we look at the, uh, post-op CT, it's very promising.
38:02So that's the half-barrel.
38:04That's the plate.
38:05That's all surrounded with cement, which goes down to there.
38:08And the plate, as you can see, takes all the load down to there.
38:11You can see the plate going right down to there.
38:14And again from the front.
38:16That's amazing, isn't it?
38:18There's a lot of hardware in there, isn't there?
38:20It certainly is.
38:21A lot of hardware.
38:23That looks Cleo-proof.
38:25I hope it's Cleo-proof.
38:26Oh, so do I.
38:28We're going to bring a mat in and we're going to do a little physio for you,
38:31show you how to do that.
38:32Okay, friends.
38:33Hello, mate.
38:34There we are.
38:35Who's in here, sweetheart?
38:37Hello, gorgeous.
38:39Hello, you're meant to be good.
38:42No, sweetie pie.
38:44There's some swelling here, which is inevitable.
38:46Yeah, I can see.
38:47You can just massage that way.
38:49Right, so just massage it with your hands like so.
38:52You can see that's already gone down, you see that?
38:54Yeah, okay.
38:55So that's just going back up the leg.
38:57And it's just maybe four times a day.
39:01Before they go, Noel wants Jane to see how well Cleo has taken to her new hip.
39:06So as you can see, she's raring to go.
39:09Yes.
39:10So that's good.
39:11Good girl.
39:12Well done.
39:13Well done.
39:14Good girl.
39:15So already she's dramatically better even just in two days.
39:18Okay, so that's it.
39:19We're done.
39:20Let's open up and we'll get her in.
39:21I'm very, very happy with her at the moment.
39:23As long as that keeps going in that trajectory.
39:25All right.
39:26Very good.
39:27Okay.
39:28Lovely.
39:29Thank you very much.
39:30She is a tough dog.
39:32So I know that she'll work it as hard as she can.
39:36All right.
39:37All right.
39:38All right.
39:39Good girl.
39:40Good girl.
39:41I'm just pleased that we've kept the leg and that she's done so well.
39:45Yes.
39:46You're a toughie.
39:47You're a good girl.
39:53Today is a big day for Mel and Rob as it's been seven weeks since they last saw Koa.
39:59It feels like forever.
40:00It does.
40:01Will he recognize us?
40:02He's only a pup.
40:03He's in good spirits.
40:06Yeah.
40:07So the bottom line is everything's going according to Pat.
40:09Yeah.
40:10So the full length of the extension is evident on this radiograph here.
40:14So that's 7.2 centimeters from there to there.
40:18That's crazy.
40:19And all of that is newborn.
40:20It's grown well, isn't it?
40:21Yeah.
40:22It looks fantastic.
40:23He should be outside the door.
40:26My heart is racing.
40:28Hello, mate.
40:29No.
40:30Who's that?
40:31Hello, everybody.
40:32Hello.
40:33There you are.
40:35There you are.
40:38Yeah.
40:39So let's take him outside so he doesn't chew it.
40:41Let's get him up.
40:45How often do we need to walk him?
40:47How far?
40:48As often as you like.
40:4920 minutes max.
40:50Really?
40:51Mel and Rob will need to perform physio at home to stretch Koa's tendons,
40:55which have not grown at the same rate as the bone.
40:57But this is what I'm talking about.
40:59I'm talking about stretching each toe so the toe must go up.
41:03He doesn't particularly like it because it hurts.
41:05Yeah.
41:06How often do we need to do it?
41:07Ten times and do it three times a day.
41:09Right.
41:10Okay.
41:11Good.
41:12So you're happy?
41:13Yeah.
41:14You know what to do?
41:15Yeah.
41:16It's lovely to get him back.
41:18He's grown so much.
41:22It's nice to see his nice straight leg.
41:25Yeah.
41:26And him so happy.
41:28We've got a bit of work to do with the physio.
41:33It looks a bit daunting to be honest, but it's for his best so head down, do it.
41:40Koa's leg will continue to grow naturally and heal over the next few weeks.
41:46Only when it's strong enough can the frame finally come off.
41:52In Kent, 11-year-old Kwanda has finally been given the all clear from cancer.
41:58Kwanda is doing brilliantly.
42:01I thought at one stage we weren't going to get her back.
42:04Now that her face has started to grow, she looks more like her old Kwanda.
42:09She's got rid of all her wrinkles and everything else.
42:13She's definitely using the eye because when you throw her a biscuit or anything, you can
42:18see her balancing and she catches it.
42:20Good girl.
42:21We've both survived cancer and it's so nice to have her back.
42:26Very good that we are a pair again, yes.
42:28To have her here and see her running around with the others and know that she's fit here
42:33again is wonderful.
42:35She's back to her normal self.
42:38In Hampshire, it's been 13 weeks since rescue dog Cleo's third hip replacement.
42:48To say that we've put everything into getting her hip right is just putting it mildly.
42:55She's a lot freer now.
42:57It was worth waiting for.
42:59Everything's gone into it.
43:01My animals are very precious to me.
43:03Very precious.
43:04She's so rewarding.
43:07She's such good fun.
43:09She lives life to the full and that's got to be worthwhile, hasn't it?
43:12Feeling Cleo.
43:13You know, they're just part of the family.
43:16It's very important to us that she's able to run and do and she does.
43:20As you can see, she's very, very powerful.
43:22And to see her running and being able to use herself properly is just fantastic.
43:29It's been a very long journey.
43:32I just wanted to be able to live her life now, you know, and I want her to maximize that.
43:37And she does.
43:39It's four months since Noel broke, straightened and lengthened Coa's deformed front leg bones.
43:50His leg is now fully grown, so the frame has been replaced with pins and a metal bar.
43:55Today, Noel will check if the bones are strong enough to support themselves.
43:59We're hoping that that metal bar is coming off today and we are very, very excited about it.
44:06We're excited for him.
44:08We have to restrict him severely.
44:09He just wants to get on with life.
44:11So the key thing here today is whether or not the bone is solid enough to take the frame off entirely.
44:26I really hope it is because no frame is designed to stay on forever.
44:31It's an anxious wait for Mel and Rob while Noel tests the strength of the bones.
44:38Okay, so the moment of truth.
44:41And looks at the final scans.
44:48Good news.
44:49Yay!
44:50I like good news.
44:51You've got no frame.
44:53Oh, that's fantastic.
44:55Thanks, Noel.
44:56That's brilliant.
44:57Finally, no pins coming out of the leg.
44:59Looks good.
45:00Yep.
45:01Sorry.
45:02That's right.
45:03Good, good.
45:04We're near the end.
45:05Near the end.
45:06Good job.
45:07Long journey.
45:08Long journey.
45:09Especially with him.
45:10Yeah, long journey.
45:11Mr. Bounce.
45:12Yeah, you've done great.
45:13After four difficult months, it's the result Mel and Rob were hoping for.
45:18Great news.
45:19The bar's off.
45:20His right leg.
45:21Happy days.
45:22It's nice to get good news.
45:24It is.
45:25For a change.
45:26Yeah, it's good.
45:27He can start going for walks of more than 20 minutes.
45:32And excellent for him because we need to take the energy out of this one.
45:42And four weeks later, Koa is finally back to his best.
45:47It's lovely to have him home.
45:49He's doing what a dog's supposed to be doing.
45:52He's very excited about life.
45:58Little things are great.
46:01Off the lead.
46:02Running the water.
46:03On the beach.
46:04You can chase him.
46:05He can chase you.
46:06We are loving life.
46:08Absolutely amazed that Noel has managed to grow Koa's leg by over seven centimeters.
46:18Koa has freedom.
46:20Running with dogs.
46:22Playing with other dogs.
46:24Being a dog.
46:25It's a dream come true.
46:38Magi is a wild female.
46:39Being a dog.
46:40You ha SPEAKER!
46:41Going to the beach.
46:42And he will join the beach.
46:43Looking at the beach.
46:44In the chillest riding place.
46:45Any Hawaii.
46:46Is sayingения can worthwhile.
46:47He can留 up the boat right now.
46:48All of you will be there.
46:49On the beach.
46:50wishes.
46:51On road to the beach.
46:52On road, Damila, Damila.
46:53And from west to the beach.
46:54On road to north to the beach.
46:56Long through up.
46:57No way we have until you're enjoying the beach.
46:58Here we have to hide.
46:59Most of the beach.
47:00Near move the knots.
47:02Here we have to walk in to our more gekommen.
47:04On road to the shorelineyang에도抑e marshes트.
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