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00:00Hello mate, you understand Irish?
00:02Animals from all over the world
00:04Ah bonjour
00:06Come to see one extraordinary man
00:08Who's known as the Bionic Vet
00:11High five!
00:12Yes!
00:13Professor Noel Fitzpatrick
00:15We only get one shot at this, here we go
00:18Noel and his team offer some of the most advanced treatments available anywhere
00:23The perfect marriage of mechanics and biology
00:25This is what we have now, a brand new knee
00:28Oh wow!
00:30For some, it's a last chance
00:33It is a life or death situation because we cannot leave him like he is
00:37I just want you to do anything you can for him really
00:40Sorry
00:41As Noel continues to devise new ways of healing
00:44You're going to be Bionic, thank you so much
00:47He transforms the lives of his patients
00:50Oh that is just unbelievable
00:52He's raring to go
00:53Against all the odds
00:55Boom!
00:56One small step for a dog, one giant leap for mankind
00:59Well done
01:12I do enjoy working veterinary medicine
01:14It's definitely a major perk to have dogs and cats around the practice all day
01:20With treating a human you can obviously explain what you're doing and justify what you're doing
01:27And with a dog or a cat all they see is this person coming at them and you can't really explain what you're doing
01:33To make the patients feel safe and secure we just fuss them practically the whole time they're here
01:43Endless fuss and usually that keeps them nice and happy
01:47It would be a bit weird I think if you do that with a human patient, maybe
01:53Just a tad
01:55Just a tad
02:05Bursting through the doors of Fitzpatrick's this morning is seven month old fox red Labrador puppy Bertie
02:12Bertie Taylor
02:13Yep
02:14If you'd like to take a seat
02:16Sue has brought him in with husband Graham who is an orthopedic foot and ankle surgeon
02:23Oh no no no no no
02:26They noticed Bertie is lame in his hind leg
02:29We thought it was a trauma because he jumped off a table in the garden and landed awkwardly
02:35And he struggles to get up on his left leg because he drags it behind him
02:40Their local vet has diagnosed Bertie with a condition in his ankle called osteochondritis dissecans
02:47Which Graham is familiar with in humans
02:50Now of course we want to know what can be done other than simply clean up the joint which wouldn't last very long
02:57You know has been using implants that we haven't been all that successful within humans
03:02So hopefully it's better in dogs
03:07Now Bertie please Bertie
03:11Hi guys
03:12Hi
03:13Hello sweetheart
03:14My name is Noel
03:15What's your name?
03:16Graham
03:17I'm Sue
03:18Sue
03:19Please take a seat
03:20Hey buddy
03:21Hey buddy
03:22It's alright
03:23Come here
03:24Firstly
03:25I understand you're a human ankle surgeon
03:27I am
03:28Which is hugely ironic
03:29Do you put in total ankles?
03:30I do yeah
03:31Do you put in partial ankles?
03:32Well we don't actually
03:34Interesting
03:35That's why we're here
03:36Right
03:37Yeah yeah yeah
03:38My life's purpose is to reconverge human and animal medicine because I think it's just foolish
03:42that we use the animal as an experiment to get the implant for the human but then it doesn't
03:47come back the other way to help the dog
03:48So that's where I come in
03:49So that's where I come in
03:50All of those implants now I have available for dogs
03:53Even some more than you have because you don't yet have an effective partial resurfacing
03:57No
03:58No
03:59The left is the worst and the right is mildly affected
04:03Well it's there but it's certainly not fragmenting
04:05Yeah
04:06They told me that the left one was the one which had some contrast going beneath it is unstable
04:12The other one didn't seem to do that
04:14Okay
04:15Can we push your chairs back? Francesca let's bring him over here
04:18There we go
04:19Alright big fella
04:20Good boy
04:21You can come over here and have a look
04:23I'm not sure I want to see actually
04:25He's very squeamish
04:26Are you?
04:27With dogs yeah
04:28Come on
04:29Not with patience
04:30What?
04:31You're kidding me
04:32He can't bear anything going wrong with the dogs
04:34What?
04:35Or the children he could never be a vet
04:36What the heck?
04:37Okay puffy
04:39Very puffy joint pouch
04:40I'm just going to do it once
04:42Yeah
04:43Yeah that's a hootcher
04:44That's a hootcher
04:45Alright
04:46Alright
04:47Alright Bertie
04:48He's very sore guys
04:49Oh
04:50He's very sore
04:51It's alright buddy
04:52It's okay buddy
04:53So if you want me to consider resurfacing I need my own CT
04:59So I'd like to do that now
05:01Thank you very much
05:02Is that fine?
05:03That's fine
05:04Okay
05:05Playtime
05:06Playtime
05:07Playtime
05:08No don't need his toy
05:10Gosh you are so
05:11He's ridiculous
05:12He's so soppy isn't he?
05:14He is so soppy
05:15He's so soppy
05:16That's brilliant
05:17I love it
05:18Bertie is taken for a CT scan to establish what can be done to treat his ankle
05:25All Graham and Sue can do now is wait for his results
05:29So it's whether we can do something to give him a good few years of playing more normally and being a young dog
05:37He's a huge part of our lives even though he's only seven months old
05:41Fitzpatrick sees its fair share of cats as well as dogs
05:54Meow
05:55They may be nimble and agile but they too sometimes need Noel's help
06:00Meow
06:02Who have we got here?
06:06Jade
06:07Next to see Noel is Joe with two and a half year old domestic short head cat Jade
06:13Jade Jade Jade Jade
06:15Take a seat you're all checked in
06:17Thank you
06:18Jade has a deformed back leg which she can't use properly
06:23We had x-rays done on her leg which showed that she'd had a partially healed fracture to her knee joint
06:31And also suffer from very very bad skin condition
06:41Hi babies it's feed time
06:44Joe lives in Surrey where she set up Happy Cats Rescue five and a half years ago
06:51The aim of the rescue obviously is to find the animals loving new homes
06:56If the home doesn't work we will always take the cat back and then we will continue looking
07:02Joe also has a house full of her own cats
07:05Hi babies!
07:07My eight cats have sort of grown over the years as when we've had cats in that you fall in love with them
07:14When I started rescue I had two
07:16Yes hang on let me get the bombs now
07:19Giving her a helping hand is her 15 year old daughter Jenny
07:23I'm an only child so having cats kind of makes up for that
07:28Jade was left at the rescue centre two and a half years ago because she couldn't be rehomed
07:34At first I kind of like wasn't sure about her
07:39But when she did come out of her shell she was a really loving cat
07:43That's why I liked her
07:45She's like my best friend in a cat
07:48To be honest
07:49Unfortunately with her medical conditions we didn't find an owner that was prepared to take her on
07:57We decided we would keep her here and we would care for her with whatever she needed for the rest of her life
08:06We've got Jade's mum
08:07Jo's tried giving Jade pain relief and has already discussed amputation or fusing her knee at Fitzpatrick's
08:15But now she's decided to go for a custom total knee replacement
08:19An operation that only Noel performs
08:22Hello Jade how you doing?
08:24Alrighty
08:26Okay let's get her out, good girl
08:28Right let me just try and get a video of walking
08:29What's happening in reception right now is it busy?
08:32Oh my goodness that's very unusual
08:36Maybe it was meant to be
08:38It's never empty out there so that's a special treat for us
08:41Yes I know
08:43Okay
08:44Okay off we go
08:46Jade
08:48Come on
08:50That's it walk up by me if you can
08:53Come on
08:55Come on
08:56Keep going
08:57Keep going that's great
08:58That's perfect keep going
09:00Yeah
09:02Well as is always the case
09:06One cannot walk pussycats
09:10Right mum we're going to take her through
09:12Is that fine?
09:13Yeah
09:14The cause of Jade's limp is clear from the CT scans taken during her last visit
09:21If we look at it in 3D
09:23We can see the kneecaps permanently out here
09:25Yeah
09:27It's very challenging from a surgical perspective
09:30Because you can see that the femur is dramatically twisted
09:33Yeah
09:34Like so
09:36My biggest concern is the quadriceps muscle here is so short
09:39When muscles been tight for a long period of time if you don't stretch them
09:42It's very hard to acutely stretch
09:44And during the op I have to acutely stretch
09:47I can't wait 6 months
09:49It's got to be done
09:50Is there a reason why you did not consider full limb amputation?
09:54Because she's young and I think she deserves a chance to keep her leg
09:59Okay
10:01Jade is settled in
10:03Oh she legs close
10:05Ready for surgery later today
10:08Thank you
10:09We're trying to do the best we can
10:10Thank you
10:11Thank you
10:12Thank you
10:13We're trying to do the best we can
10:14Give me all the kisses
10:15Why are they so pretty?
10:16Why are they so pretty?
10:28Birdie the 7 month old fox red labrador puppy has had CT scans to assess what can be done to alleviate his painful ankle
10:31Bertie, the seven-month-old fox red Labrador puppy, has had CT scans to assess what can
10:41be done to alleviate his painful ankle.
10:44I love red Labradors. I'm going to say that I'm fox red now. I'm not Ginger, I'm fox red.
10:52This is beautiful.
11:00These are the CT scans right here. There's a massive hole on the left side. It's a critical
11:07size defect. The other side, unfortunately, is affected, but to a lesser extent. If we
11:15look at the lesion, it's the same but smaller. So you're here in time, but only just.
11:23To a little thing?
11:25Yeah. I absolutely do not think the fragment removal is going to be of any use whatsoever.
11:30So we either go down the route of tablets until you get a bit older and fuse it. But
11:36with two ankles fused, you'll have a stilted dog forever. Or crack on as soon as we can
11:42and put a resurfacing in there.
11:45At such an early age, the bouncy pup is facing not one, but two ankle operations.
11:52Well, I mean, think about it. Yeah, I don't think we need to think about it. Right. So
11:56I'll ask the engineers to look at the CTs tonight. I'll come back to you with an answer tomorrow
12:01at the time frame. OK, brilliant. Yeah.
12:05Good boy.
12:07Both of his legs are affected. The left's a lot worse. So basically you're going to have
12:11a sort of partial joint replacement in each. Because without it, he'll not only be in pain,
12:16he'll get arthritis quite quickly anyway. It's just upsetting because you can't explain
12:22to him what's happening. Whereas with a patient, you can do that. And I find that quite difficult emotionally.
12:27It's early evening. Jade, the rescue cat, is being prepared for her total knee replacement.
12:47Her implant has been 3D printed based on her CT scans. But operating on Jade won't be routine
12:55due to her deformed leg. So in real life, the kneecap should be somewhere up here, on the
13:02front of the knee. But instead, it's over here on the side of the knee.
13:08Noel's first challenge is to cut out the deformed joint and prepare the fragile bone for the
13:14implants. So I've made sure that I can flex the ankle and line up the front of this implant
13:23and so it's exactly perpendicular to the tibia and exactly parallel to the ankle.
13:29If the implant isn't straight, then Jade's kneecap could continue to dislocate.
13:35OK, I think that looks pretty good. Now we'll prepare the femur.
13:42You can see here where we've shaped the stem in a curve to fit the very curved femur when we push it in.
13:48So this is very difficult to sculpt because the femur is bent both on the outside and the inside.
13:55So the marrow cavity is also bent.
13:59Finally, Noel needs to relocate the kneecap into the groove
14:05and connect the tiny femur and tibia implants with a specially hinged plastic bushing.
14:15You can see here that the knee can flex, extend and also rotate.
14:22So physiotherapy is going to be critical to success.
14:27We've no idea yet how Jade is going to use this knee.
14:31The function will be entirely dependent on whether the quadriceps muscle can loosen up enough to flex.
14:38We can only do our best.
14:40OK.
14:42This morning's patient is also looking to Noel to fix a painful knee.
15:01Jo's brought in her four-year-old springer spaniel, Sophie.
15:04Hello.
15:05Just take a seat.
15:06They're not going to be long.
15:07Thank you very much.
15:12We're here because when she was a pup, she had luxating patellas.
15:17So basically it's the kneecap slipping in and out of the joint.
15:21It's not staying in.
15:25Jo lives 400 miles away in Cheshire.
15:29I live on my own with my three dogs, Hope, Sophie and Indy.
15:34Indy is currently nicknamed Dobby because she keeps stealing socks.
15:39Indy.
15:40Hi.
15:41Indy.
15:42Oh, I love the springer spaniel breed.
15:46It's good.
15:48Due to Sophie's condition, she's not been able to join in the games.
15:54They are a lovely family unit and they include me in that as well, which is nice.
16:01There's a good girl.
16:03I know some people don't seem to understand that bond between people and dogs sometimes,
16:09but for me it's a very profound bond.
16:12Indy.
16:13Where's it gone?
16:15And I do have to remind myself that they are dogs, not children.
16:20The others are still doing that, sort of running around and just clearly loving life.
16:26That's why it's so sad with Sophie a little bit is because she's so tied down.
16:31Sophie's had three surgeries already so far and time away from me has made her even more clingy.
16:40But certainly if we ever go back to the vet's, she'll sit on my knee and cuddle in just wanting reassurance.
16:47Sophie's operations were for a slipping kneecap and a cruciate ligament rupture on the same knee,
16:54but both failed to hold the kneecap in place.
16:57And she's also had surgery on her right elbow.
17:01I can't see what else they can do.
17:08Sorry.
17:10I see it as her last chance to get it right.
17:14I feel like I've tried to do my utmost with the physio and the hydro and doing it at home.
17:20And it just hasn't worked.
17:23So I think it's just wanting a final surgical solution.
17:26So it's 13 months and I just want her to be okay.
17:31Sophie, please. Sophie.
17:34Jo's local vet has sent Noel Sophie's medical history with x-ray pictures of her diseased joints.
17:41Nice to see you. Nice to see you.
17:42You okay? Please take a seat. You on your own?
17:44Yes, I am.
17:45You're a doctor?
17:47Not medical.
17:48What kind of psychology? I definitely need you.
17:51Yeah, right, you're hired.
17:54That's good.
17:57Okay.
17:58So which leg has she got a Luxating Patel on?
18:01Both, but it's the right one that's had the operations on it.
18:05When I extend it, the easy comes out and then it's completely out.
18:10Okay.
18:11And when I put it back in, it's in.
18:13Yes.
18:14Yeah, it's a tough situation, isn't it?
18:17Mm-hmm.
18:19Despite her multiple surgeries, Sophie's kneecap is still dislocating.
18:24The elbows concern me as well because they're pretty significantly affected by osteoarthritis.
18:31Can you tell that from the x-ray?
18:33Yeah, on the right side especially, but also on the left side.
18:40In terms of the left knee, we wouldn't do anything at the moment. It's static.
18:44With regard to the right knee, this kneecap was slipping that way and that way.
18:49What you want to do is you want to try and stop the kneecap coming out sideways.
18:53You've exhausted all reasonable possibilities of deepening the groove and you've exhausted all reasonable possibilities of moving the front of the kneecap attachment over.
19:03If the alignment was okay, then there will be ways to address it.
19:08One would be to put on artificial ridges to stop it slipping out.
19:14Yeah.
19:15And the other question is whether we perform arthroscopy on the elbows at the same time or not.
19:19Okay. For me, you are her last hope in relation to her back leg at least.
19:25I wasn't expecting the front legs today, but, you know, I'd be grateful for them to be done.
19:31I certainly think we should check it.
19:34I hate the thought that she is in pain.
19:37Leaving her behind was hard, but she needs surgery and that's that.
19:50Okay. There you go.
19:52I just want her to be better, I suppose, at the end of the day.
19:56After taking radiographs and CT scans, Noel uses an arthroscopic camera to look inside Sophie's joints.
20:05He will try and save Sophie's right hind knee joint.
20:10It's just the ridges on either side are not high enough to keep the kneecap in.
20:18And that's the problem.
20:20Instead of removing the whole joint, Noel will design an implant that will aim to keep the kneecap in place.
20:27Next, he moves onto Sophie's front legs.
20:33You can see that there's raw bone here with no cartilage on it.
20:38That's not good.
20:40So that's rubbing.
20:43Noel will have to operate.
20:45So what I'm going to do is I'm going to cut the ulna.
20:48The top part kicks down and back and then it heals itself without any stabilisation.
20:53So no pin, no plate required.
20:57Luckily, Noel won't have to operate on Sophie's other front leg for now.
21:03There we go.
21:04The ulna is free to move.
21:07It's obviously not going to cure the arthritis, but it should certainly help to decrease pain in the elbow as a result of rubbing.
21:17It will take about 8 to 12 weeks for this to heal properly.
21:21During that time, we'll be making the new ridges for the knee.
21:26So the timing is just about right.
21:31Sophie can go home in a couple of days to recover.
21:34But she'll have to wait for a custom implant to be made to repair her slipping kneecap.
21:40You've had to wait for a while to keep her underneath her.
21:54Contact home.
21:55Okay, Bertie down.
21:56First to Bertie, contact.
21:57Sue has brought in seven-month-old Labrador puppy Bertie.
22:01Next Bertie, come here.
22:03Her son, Johnny, has come to help,
22:06has come to help,
22:07although he too has struggled to restrain Bertie.
22:11I think the frustration got hold of Bertie this morning
22:13and I picked him up to stroke him
22:15and he's gouged my nose out here.
22:18And the last four months or so,
22:19we've had him on the lead a lot
22:21and he's just had a lot of pent-up energy.
22:25Bertie's gonna have his first of two operations.
22:28He's having resurfacing of his ankle joint on his left leg.
22:32Very nervous.
22:34Bertie Taylor, please.
22:36Bertie Taylor, please.
22:41Hi guys.
22:43How are you today?
22:44Hello, mate. How are you?
22:45I heard the dog scratch you, I'm sorry about that.
22:47Yeah, he's doused me.
22:47Oh, dear.
22:49Yeah, he's very boisterous, isn't he?
22:51He's very boisterous.
22:52Here's some tissue.
22:54There you go.
22:55Right, okay, so you know what I'm doing today.
22:58I'm going to put a custom ridge on to his ankle joints
23:01or we'll give him some sedatives to help him to cope.
23:04Yeah, I think that's our main worry is we're not quite sure how he's...
23:08Yeah, it's everybody's main worry because he's so boisterous, as you can see.
23:12I'm sorry about that.
23:14OK, guys, God bless. See you later. Bye-bye. Bye.
23:23Hopefully, when he's had the surgery,
23:26then he'll get back to being a lovely puppy
23:28that can actually get rid of his energy
23:31and then he won't be quite so mad.
23:34First, Noel will access the joint
23:42by temporarily removing a piece of tibia bone.
23:46Next, he opens the ankle
23:47and prepares the diseased surface to place in the new custom implant.
23:53Finally, he'll fix the ligament attached to the piece of tibia back into position,
23:57securing it with special eyelet pins and wire.
24:04As we open up the ankle,
24:10so we can see here where the big hole is,
24:12and unfortunately, that big hole of raw bone
24:16has already rubbed away a bit on the other side here.
24:18We're just going to sculpt the correct shape in order to put our implant in.
24:26So we want this to fit just right.
24:35OK, so that's the metal ridge in place now.
24:37We've filled the hole.
24:39What we're going to do now
24:39is going to pop it back up into the joint like so.
24:43The hope is we can give a functional, healthy, pain-free joint for a long time.
24:48And then we'll do the other side in six weeks.
25:06Jade, the rescue cat, has been recovering at the practice for nine days
25:10after her total knee replacement.
25:12But she's still got a long way to go.
25:15She'll need intensive physiotherapy and laser treatment daily
25:19to stretch her contracted muscles.
25:21Hello.
25:22How are you?
25:24I'm all right.
25:24Good.
25:26Jo has returned with her daughter Jenny for a visit.
25:31Jade adores my daughter,
25:33and she's missed her like crazy.
25:36She loves her cuddles with you as well, doesn't she?
25:38Yeah, I've missed her a lot.
25:41Hello, friends.
25:42There we go.
25:43Come on, Bubba.
25:45So as you can see,
25:46there is an effort to use the leg now,
25:48but it's still too straight.
25:51OK?
25:51So what we're encouraging every day is this.
25:55Like so.
25:55So she's got to put that down.
25:56Yeah, so she's got to put that down.
25:57You see that?
25:58Pick her up there.
26:03She's wanting to pull it forward, but she can't flex it.
26:06Come on, beautiful.
26:07I'm still concerned whether we're going to get function or not
26:12into that quadriceps,
26:13because it's been deformed for so long.
26:17She's been with us 18 months,
26:19and it's just been slowly getting worse.
26:22Yeah, well, you're not going to reverse 18 months or two weeks?
26:24No, of course we're not.
26:25No, I appreciate that.
26:26And as I said to you from day one,
26:27it will take as long as it takes.
26:29Yeah.
26:29OK, bub, here you go.
26:32Well done.
26:33Good.
26:35It's definitely hard leaving her behind,
26:38but we know we're on the road to getting her better and fixed
26:41and hopefully using that leg again properly.
26:43So we're going to be waiting now with bated breath for updates.
26:49See you later, ladies.
26:53We'll see you again.
26:54Lively Labrador pup Bertie has been at the practice for a week
27:11after having his first partial ankle replacement.
27:16Take your seat.
27:17I'll let him know you're here.
27:19Sue has returned to pick him up
27:21with her other son, James, to give her a hand.
27:24Very excited here.
27:26I'm a bit worried he's going to go mad.
27:29Hopefully he won't scratch us like he'd scratch Johnny.
27:35This is your new ankle ridge replacement.
27:38As you can see, the objective of the operation
27:40is to replace the entire defect with this cap.
27:44The cap is a super smooth surface
27:46that will rub forever on the opposing surface of the tibia.
27:51Super clear?
27:52Yeah.
27:53Good.
27:53Very clever.
27:54Post-operative confinement is the main thing.
27:57So no running, no jumping, no slipping, no sliding.
28:00If the family manage to keep Bertie calm...
28:03Hi, Bertie.
28:05..and everything goes to plan,
28:07he will have his right ankle surgery...
28:09..in six weeks' time.
28:11Come on, mate.
28:12Now, here we are.
28:14It's up to us now, really.
28:15We've just got to make sure that he doesn't leap around or jump
28:18or what have you,
28:19so that he's got the best chance of it working, really.
28:23So we've just got to do our best.
28:25It's lovely out there.
28:37It's all right.
28:38I'll stay in here.
28:39Keep warm, keep dry.
28:43The day has come for Joe
28:44to leave Springer Spaniel's Sophie
28:46at Fitzpatrick's once again,
28:48this time for surgery on her knee.
28:50You are pups.
28:52You're going to have to stay here.
28:55I know.
28:56I know.
29:02OK, it's OK.
29:04Hopefully this operation will be Sophie's last.
29:09When I left her with, she was just looking.
29:12It was just...
29:13Don't believe me, Mum.
29:14She's my child, and I love her.
29:20That's partly what's crucifying, is...
29:23I mean...
29:25Yeah, just...
29:27She can't play or anything like that.
29:32She is the dog that's with me all the time.
29:35So it's like I've lost my shadow.
29:37First, Noel starts by preparing the joint
29:44for the new custom implant.
29:47We've drilled away the cartilage
29:49from the old worn groove,
29:51and now we're going to put a new smooth groove on.
29:54Noel uses bone graft collected from Sophie's bone
29:57to create a bed for the new groove to sit on.
30:00This implant is made out of cobalt chromium,
30:03which is three-dimensionally printed from the CT scan.
30:07The undersurface is made out of a mesh.
30:13We've coated it in a mineral called hydroxyapatite,
30:17which attracts bone cells onto it.
30:31OK, so we're just going to put the kneecap
30:33back into the groove now.
30:34There we go.
30:35Stitch up.
30:35We're done.
30:37So the kneecap is gliding nicely at the moment.
30:40Let's hope it stays that way.
30:52The practice has a specialised rehabilitation centre,
30:56including hydrotherapy pool.
30:59For many, it's the gateway to a full recovery.
31:02Good boy.
31:05Usually, it's the dogs getting the benefit.
31:09But surprisingly, cats can enjoy it too.
31:15Some of the time.
31:18Jade is having hydrotherapy,
31:21a beneficial treatment to help stretch her quadriceps muscle
31:24after her knee replacement.
31:25After two weeks of daily rehabilitation,
31:37she's progressing enough to go home.
31:39In just a week, the improvement there is massive.
31:51A little bit apprehensive about the rehab, but we'll just keep going and play it day by day
31:54at the moment.
31:55My daughter's really, really happy to have her home.
31:58She's her little baby.
31:59So, yeah, she's over the moon.
32:07Down in Hampshire,
32:11Bertie, the Labrador pup,
32:14is at home recovering after having his second ankle surgery.
32:19Bertie.
32:19He's on strict cage rest.
32:22I hadn't realised how hard it was going to be to have him in the crate.
32:28You can't leave the room.
32:30He starts to cry or get upset.
32:34It's just the sad look that is the worst thing.
32:39Every time you do take him out,
32:41you're terrified that he's going to damage it.
32:43It's very intense, to be honest.
32:45It's not what a puppy should be doing, really.
32:52It's, you know, he should be having fun and being able to play.
32:59Bertie, shh!
33:01He's, you know, he's missed out on being a puppy.
33:15It's three days after Sophie the Springer Spaniel
33:27had what Jo hopes is her final knee surgery.
33:31She's arrived eager to collect her companion.
33:35I've probably described myself as nervously excited for some reason.
33:38I don't know why.
33:40I just haven't been able to get her off my mind.
33:42This is what your implant looks like.
33:46Right.
33:46So you can see that the surface architecture of this implant
33:49has been designed to perfectly contour the original femur.
33:54But I'm very pleased with that.
33:56And so is your dog.
33:57So if you push your chair back, I will show you.
34:00Come on there.
34:01There we go.
34:02Good.
34:03Now.
34:04Hello, Mummy.
34:05Baby, hello.
34:07Hello, Mum.
34:08Doing fine.
34:09Oh, baby.
34:10Doing fine.
34:11She's actually walking on it without too much trouble.
34:14The kneecap's in a very nice position.
34:16It's central.
34:16Everything's good.
34:17She's wagging her tail.
34:18She's happy.
34:18Okay?
34:20All right.
34:20My entire pleasure.
34:21It's great.
34:22I mean, you love her very much.
34:23And she's very lucky.
34:24You're very lucky to have each other.
34:26Like with the harness, don't let her jump.
34:28No.
34:28And then we'll just support her like that.
34:30And her back end.
34:31Okay.
34:32Oh, I've missed you this time.
34:34Hello.
34:36Now, no messing with Sophie in the car, okay?
34:37Be good with her.
34:38She's still a bit fragile.
34:39Well, please.
34:40Safe journey.
34:41Thank you very much.
34:42No worries.
34:43Take care.
34:43Bye-bye.
34:45Are you back home now, darling?
34:47Yes.
34:48It's going to be fine.
34:49I can't say.
34:50Good girl.
34:50Stay there, baby.
34:51Good.
34:51Good girl.
35:03Orthopedic ankle surgeon Graham and his wife Sue are back with Labrador Bertie six weeks after
35:09his second partial ankle replacement.
35:12Well, he's still holding that leg up a bit.
35:14Oh, I don't know if it's hurting him or not.
35:17Not as good as the other one.
35:19Graham is concerned there could be a problem with this second surgery.
35:22When he's out walking is good, but when he pauses, he will sometimes lift it.
35:29Not always.
35:29Yeah.
35:29So I'm sort of worried to death.
35:32Yeah, yeah, yeah.
35:33Bertie.
35:34All right, let's just take him through.
35:35That's fine.
35:36Okay, let's just go through now.
35:37Okay, let's go straight through.
35:39Yeah, all right.
35:40Thanks.
35:43Bertie is immediately sedated and taken for a CT scan.
35:47While Graham and Sue wait.
35:54When Noel operated on Bertie's second ankle, he added a metal plate on the side to stabilise
36:00the repair.
36:02The results are in.
36:05Sadly, your hunch was right.
36:08There is something wrong.
36:10It's very unusual.
36:11I've not seen it before.
36:13What he's done is he's actually cracked the implant.
36:15Not the metal.
36:17The metal.
36:21The other side, when we rotate it, you can see that there's a nice smooth ridge, and
36:27it's actually integrating well.
36:29There's no issue.
36:33But on the other side, which is the side that's affected by the swelling, but he has
36:39cracked the metal here around the peg before the bone has grown in.
36:47So I think what's happened is for whatever reason, in the cage or otherwise, he's pivoted
36:52on it, because direct compression shouldn't crack it, because it's got a bone bed to sit on, and
36:58it's a tight joint.
37:00We have some of these out three years now, and they're still fine.
37:04But I've not seen one crack yet, because clearly he's putting more load on this than any dog
37:11we've had before.
37:12Well, you've seen what he's like.
37:13Yeah.
37:18I can't leave that the way it is.
37:21So I've got to replace that, and I'll probably have to take off a couple more mill of bone
37:25and make it thicker shell.
37:27And I obviously feel awful about it, but...
37:30No, no, it's not.
37:31Don't do it.
37:32Yeah.
37:33As, well, you'll understand, as a surgeon, you're going to get complications, but I definitely
37:38did not see that one coming.
37:39OK, give me a couple of sacks.
37:45I'm sorry.
37:46OK.
37:49You're all right to be doom and gloom, aren't you?
37:52It's better than the infection, Sue.
37:54Oh, no.
37:57I mean, he's potentially solvable.
38:01Poor little thing, I just feel sorry for him.
38:03Oh, well, that's why we feel awful.
38:04Not only our other breeze, is it?
38:06I mean, you just feel dreadfully sorry for him.
38:09Hello, Bertie.
38:14Hello, Bertie.
38:15Hello, you crazy boy.
38:18I'm sorry, mate.
38:19No, thank you.
38:21Stay brave.
38:22OK, thanks, Mel.
38:24Bye.
38:24It's a major setback for Graham and Sue.
38:28Bertie will need yet another surgery to replace the broken implant, but must wait for a stronger,
38:34thicker implant to be made.
38:37Look at his little face.
38:39Something had to be wrong.
38:41It's just going through it all again for him.
38:42He can't play.
38:43He can't do anything.
38:46You couldn't listen to that for long, could you?
38:48No, no.
38:48Boisterous Labrador pup Bertie is back at the practice for his third surgery, a week after breaking his ankle implant.
39:16It's a big day, in more ways than one.
39:21Is it his birthday today?
39:23No.
39:25What a shitty way to spend your birthday.
39:28What a great way to spend your birthday.
39:31Oh, my God.
39:34Yes.
39:35Oh, I love it.
39:35Bertie is one year old today.
39:37Okay, so this implant is thicker.
39:47It's got a thicker surface in here in the middle around the peg, so it's less likely to crack.
39:54So that's our new implant in place now.
39:56It looks like a nice fit.
39:59I'm happy with that.
40:00It's seating down nicely.
40:01Okay, so now we put the plate back in.
40:11Sue will collect Bertie in a couple of days, in the hope this second implant will withstand Bertie's bouncy behaviour.
40:18Joe is back with Springer Spaniel's Sophie.
40:32Good girl.
40:32Good girl, too.
40:33She's hoping that Sophie's latest surgery has finally stopped her kneecap slipping.
40:39All right, Sophie.
40:40Good girl.
40:42Nice to have a little bit here.
40:43Good girl.
40:43Good girl.
40:43Well done.
40:44So you've been following the rules, I can see.
40:46I've been doing my best.
40:48Right.
40:49Has she escaped at any time?
40:52She's got on and off the sofa.
40:54Well, at least you're being honest.
40:56Mm-hmm.
40:57So I'm going to take an x-ray picture to make sure that the illness is healing,
41:01as well as an x-ray picture of the right knee.
41:05Today is an important day because today is all about is the kneecap tracking appropriately and is the implant intact?
41:13Yeah.
41:13One of the things I've forgotten to mention, actually, she's actually in season.
41:19All right.
41:20And my other dog is quite gay with her.
41:23Oh, I see.
41:24And I turned around when she came in disease and then she was twice, she'd got onto a bat.
41:28I was like, no!
41:29Humping and jumping.
41:31No.
41:31I couldn't believe it was something I had to touch on.
41:34Okay.
41:35That wasn't on the post-operative confinement sheet.
41:39It should say no humping and no jumping.
41:45The x-ray pictures have been sent through.
41:47The good news is that the line of the kneecap is very nice now and it's in its groove and it's seated very nicely.
41:54And the elbow, now you can see Bonnie healing there, so that's all hunky-dory.
42:02No need to cry.
42:03At least there are tears of joy.
42:06I know.
42:06It just feels like it's been a long, long journey.
42:08Long journey.
42:09Now, you still have a little bit of the journey to go because you've lost a shed load of muscle, you know.
42:12Yes, yeah.
42:14That seemed to go overnight.
42:15Yes.
42:16Yeah, that needs to be really worked on.
42:22Now, there we go.
42:24You're welcome.
42:25Well done.
42:26Now, no off-lead and no humping and no jumping.
42:29No, no, no, no humping.
42:31No jumping.
42:32Okay.
42:34All right, take care.
42:37No humping, no jumping.
42:42At home in Cheshire, Joe and Sophie are taking their homework very seriously.
42:54If I get up at half past four, I do the muscle stimulation with her before we go out for a walk.
43:01It probably takes about an hour by the time you've got the pads on and everything else.
43:06And at some stage during the morning, I'll do her physiotherapy exercises.
43:10It's probably walking over the poles.
43:13Good girl.
43:14Sit to stands.
43:15Good girl.
43:17I've had to cut my work hours down to half.
43:21It doesn't sound very much, actually, but it feels as though it's quite constant during the day.
43:26Is that all we do, Soph?
43:32And the hard work has paid off.
43:34So I started letting her off the lead just a little bit in this garden, but it's not very much at all.
43:39I do get a little bit worried if she picks up speed and she starts running around in circles and things and hopping as she goes.
43:46So I'm trying mostly just to keep her exercise nice and steady.
43:49I have managed to avoid Sophie being humped, especially because my other two dogs are in season.
43:55My oldest one tried and then I managed to stop her in time, so that's okay.
43:59I'm going to give you a kettle.
44:01I'm very, very grateful to Noel for what he's done.
44:05She's got a lot of years ahead of her still.
44:12At home in Surrey, after a gruelling four months of physiotherapy to stretch her leg muscle,
44:18Jade is finally making steps in the right direction.
44:22The op obviously was the major part of getting the knee fixed, but without the physio we wouldn't have the cat we've got today.
44:31Jade does live in a house with eight other cats, some she doesn't get on with quite so much.
44:38But, you know, being able to move around more freely now and be able to run,
44:42she can choose who she interacts with and who she doesn't.
44:45She tends to stick with upstairs and she has her own little space.
44:53Hey, good girl.
44:54Yeah?
44:55Come on, get it.
44:57Whoop!
44:58Yay!
44:59She's playing really well.
45:01She loves to jump around, run around now.
45:04She never used to do any of this, so it's just amazing to watch her.
45:07Hey, good boy. Look at you.
45:17In Hampshire, after three surgeries and nine months of treatment,
45:21Bertie, the energetic Labrador, is finally catching up on his missed puppyhood.
45:27He's doing really, really well.
45:29We're really pleased and he's really able to play with Ollie and just have a great time.
45:34It's left its mark. We've both put on half a stone.
45:36Comfort eating. You know, you get quite depressed looking at the dog behind bars.
45:42It's all been worth it, I think.
45:44He's comfortable, he's cheerful.
45:46He's jumping on the furniture again if you don't really keep an eye on it.
45:51I'm pleased that we went for the partial resurfacing rather than having a fusion.
45:56We felt it was unfair in a young dog to do that, really.
46:01I'd like it very much if we had an implant that we could use in humans,
46:04which is similar to the one that Bertie's had.
46:06The technology's there, it could be done.
46:08Clearly it's been done in Bertie.
46:10So there are a few patients who'd benefit from that.
46:14It's just lovely seeing him, you know, just bounding around the garden and exploring.
46:19It's just lovely to see.
46:21You can step in the distance to see.
46:22I'm here for you.
46:25I'm here for you.
46:37I'm sorry.
46:39You seem to be the same person that I know.
46:41I'm here.
46:43I'm here for you.
46:45You
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