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00:00I don't see Uncle Noel.
00:02Superheroes don't always wear capes.
00:05So cute, oh my god.
00:07I've got a new friend, he's beautiful.
00:09Professor Noel Fitzpatrick and his team
00:12You can have some nice eggs, me.
00:14Offer cutting-edge solutions.
00:17You're glad to be there, dream these things up.
00:20I dream a very little else.
00:22To help save the nation's pets.
00:24This has to be done within the next 48 hours.
00:26Coming through.
00:27Please be okay, please be fixable.
00:30You only get one chance at this.
00:31I just have to hope my best is good enough.
00:34Come on, you're a trooper, you'll be okay.
00:36Transforming the world for families.
00:39What have we got here?
00:41One animal at a time.
00:43That's crazy.
00:45He is just back to living his best life.
00:48You've got Superdog.
00:49He told me modestly that it was technology
00:51but it was so much more than that.
00:53You're cute.
00:54He'd worked a miracle.
00:55No, it's me.
00:56Yeah, it's going to be all right.
01:03Come on, nice and slowly.
01:04Gentle.
01:05That's perfect, isn't it?
01:07You're gorgeous.
01:08At the heart of Fitzpatrick referrals
01:11is a deep love of all animals.
01:13Oh, he's adorable.
01:15I am a massive sucker for Hungarian visualers and German shepherds.
01:20Good boy.
01:21But some steal hearts more than others.
01:24This is my child.
01:25I actually have a real soft spot for Italian greyhounds.
01:28They're so funny, so full of character.
01:31Oh, she's so sweet.
01:32All sorts of breeds, large or small.
01:35Isn't he cool?
01:36Tall or tiny.
01:37The little paw.
01:39Spotty or fluffy.
01:41He's so gosh darn cute.
01:42Every time we have a Pomeranian at the practice,
01:45they always say,
01:46Ruben, there's a Pomeranian here.
01:48Do you want to see him?
01:49He's like, yes.
01:50They really know I love Pomeranians.
01:52High five.
01:53High five.
01:54Good boy.
01:55I know I shouldn't be biased,
01:56but I do have two Maine Coons in my life.
01:59They're so affectionate,
02:01and they're just the best stress-busting companions
02:04you could ever wish for.
02:10Hello, this is Lexi.
02:12Take a pew.
02:14And help yourself to tea or coffee, okay?
02:17Or hot chocolate's nice.
02:20One-and-a-half-year-old Maine Coon Lexi
02:22is here today with Lucinda and Duncan.
02:25About two weeks ago,
02:26we've noticed that she's been quite all alone by herself,
02:30like hissing,
02:31and as she's walking, she's been limping,
02:33so we just decided to take her to the vet,
02:36got x-rays,
02:37and it looks like she fractured her left hip.
02:40Obviously, it's very sad to see her not doing well.
02:43She means the world to us.
02:44It's our first cat together,
02:46and she just climbed into our hearts immediately
02:49with her big Maine Coon paws.
02:51Lexi came into South Africans' Lucinda and Duncan's lives
02:56after they decided to make the UK their home.
02:59I've always been a dog person.
03:01I've had dogs my whole life,
03:02but Lucinda wanted to introduce me to Maine Coons,
03:05so it brought into the idea of giving a cat.
03:08Lexi!
03:09The idea of just having a big fat cat cuddling
03:13is just really nice.
03:15The couple fell in love with Maine Coons,
03:18one of the largest cat breeds,
03:20and not long after getting Lexi,
03:22she was joined by baby brother Levi.
03:25Lexi and Levi is literally our world.
03:28I can't imagine my life without them.
03:33Very quickly,
03:34Lexi confirmed her place in the family pecking order.
03:37Lexi is queen of the house.
03:39She's definitely ruling the household.
03:42What are you doing?
03:43Lexi's guilty pleasure is an ice cream.
03:47When you open that wrapper, she knows.
03:49And if I don't give her the leg,
03:51she will literally use a paw and go like that.
03:54She just absolutely loves it.
03:56But when Lexi fractured her hip, everything changed.
04:00I'm trying to compare her life before she had the injury.
04:06She was really playful, jumping everywhere.
04:08It's a big challenge for a other cat
04:10because Levi wants to play the whole time.
04:12For me, the definition of a cat is
04:15to be able to jump on anything you want to jump on.
04:18Run around crazy like a hooligan,
04:21and seeing her not being able to walk properly,
04:24just lying there, not being Lexi was heartbreaking.
04:28Hi, guys.
04:33Come on and grab a seat right there.
04:35Now, I love main cones.
04:38Like I'm crazy.
04:40So, I'm going to ignore you completely.
04:43I have too.
04:46And I love them like the joy of my life.
04:48How are you?
04:50Now, tell me how the incident happened, please.
04:53So, we actually have no idea how she hurt herself.
04:56Right.
04:57I took her to the vet thinking maybe the smaller baby
04:59that we have at home, maybe just caught her.
05:02You have a baby?
05:03Yes.
05:04Not a real, a mancoon.
05:05No, we both have two cat babies.
05:07Yes.
05:08So...
05:09Give her a go slowly on my knee.
05:11See what happens.
05:12That's it.
05:13There we go.
05:14It's okay.
05:15Shh.
05:16I know you're in pain.
05:17I know you're in pain.
05:18It's okay.
05:19Shh.
05:20Obviously showed the fracture.
05:21So, now we're here.
05:23I know.
05:24I know.
05:25I get it.
05:26It hurts.
05:27I don't need to pull her about because I've already seen an x-ray picture from your vet.
05:32So, this is a hip.
05:34Now, what you may have thought was going on was that we had a loose hip.
05:39That's not what you've got.
05:40Okay.
05:41It's called a slip capital femoral epiphysis.
05:44And slip capital femoral epiphysis is a big problem.
05:47The blood supply comes up through the femoral neck into the head.
05:51The blood supply comes down through the ligament into the head.
05:54And it joins in the middle.
05:55Now, there seems to be some kind of probably genetic predisposition
06:00that determines that the interlinking of those blood vessels doesn't work right.
06:05And when that happens, then the blood supply gets cut off and the neck rots away.
06:10And eventually, it just splits.
06:12And then the femur is separated from the femoral head by a hole.
06:16If a cat jumps from a height or twists awkwardly,
06:21they can twist the head off the femur at that plate.
06:24And that's what we believe has happened.
06:26And so, you can't get comfortable.
06:28I know.
06:29I know.
06:30I know.
06:31Now, to treat it, option one, femoral head and neck excision,
06:36where you chop off the head, chop off the neck and throw it away.
06:39Okay.
06:40That leaves a piston-type motion, so you've got no hip joint, just a fibrous pad.
06:46They never exert full weight on the leg.
06:48But most cats do fine with it, or total hip replacement.
06:52Yes.
06:53Total hip replacement can be very successful in cats and give them a normal life.
06:57But it's really up to you what you want.
06:59Would she need one hip replacement or two?
07:01We won't know till we get the x-ray pictures.
07:04Maine coons seem to be genetically more susceptible to this condition.
07:10It's more common in young males, and it can affect both hips.
07:15This cat means the world to me has been heavy on our hearts having to make a potential call
07:20that we don't want to make.
07:22So, if it's the one that's a full-on hip replacement, do what needs to be done to get her better.
07:28If it's unfortunately the two...
07:30Well, do you want to hang about while we get the rads?
07:32Yes.
07:33Okay.
07:34Right, Reuben, you've got a new friend.
07:36Oh, good morning.
07:37Beautiful, beautiful.
07:39Now, she will hiss at you, but use the Reuben charm.
07:45Before being x-rayed, the team are using a pressure-sensitive walkway
07:49to see how much weight Lexi is putting on her back legs.
07:54But Madam Lexi doesn't want to strut her stuff.
07:58Go on, Lexi.
07:59Go on.
08:00They're showing us up.
08:01They're showing us up, usually.
08:02I do like a good, big fluffy Maine Coon.
08:05But you have to have a lot of patience with cats.
08:08There's a few footprints.
08:09That's all we need.
08:10That's all we need.
08:11They seem to be a bit less tolerant than dogs.
08:13Even the comfort of her cat box isn't tickling her fancy.
08:19But as long as you've got the patience, then usually you're on to a good start.
08:24Not always.
08:25The dog.
08:26Yay!
08:27Yay!
08:28Yay!
08:29Yay!
08:30Yay!
08:31I got one.
08:32I got one.
08:34Do it all.
08:35Yeah, no, that's one for the second.
08:36You sit up there and I think you're back.
08:38I got one.
08:39I got one.
08:40I got one.
08:43Hi guys.
08:44Hi.
08:45Come on in.
08:46Come on in.
08:47Now, I do have bad news.
08:49It is both sides.
08:51I'm sorry.
08:53That was not evident on your previous x-ray pictures.
08:56But it has got a lot worse since.
08:58Which sadly is not uncommon.
09:01Sorry.
09:03You can see on the frog leg view that the femoral head is separated on both sides.
09:08Bookhead.
09:09No wonder she's in pain all the time.
09:12Because it's moving like that.
09:14I've personally never seen a bilateral slip capital femoral epiphysis in a female Maine Coon Cat.
09:24Ever.
09:25In 30 years of doing this.
09:27She's literally one in a million.
09:30In a good way and in a bad way.
09:33Bottom line from your perspective is what are we going to do?
09:38I think for us we'll need to assess the cause side of things.
09:43Of course.
09:44And that's the difficult part for me.
09:45It's the worst decision that I need to make in my entire life.
09:48I understand when a cat is like 13 years old, they've had their lifespan.
09:52Which is a year and a half.
09:55With two of Lexi's hips affected, the family now have an agonizing decision to make.
10:01A simpler procedure, leaving her without a joint.
10:04Or the chance of full mobility with a more complex hip replacement.
10:08Ricochet and Excalibur, the two boy Maine Coon cats,
10:12that I'm lucky enough to have in my life,
10:14are both in the age group that could get slipped capital femoral epiphysis like Lexi.
10:20And if that happened, I'd be devastated.
10:27What are we going to do?
10:29I can really empathize with what Lexi's family are going through.
10:34She's my baby, that girl.
10:35She's my baby, that girl.
10:36It's watching...
10:39It's watching referrals. How can they know?
10:41No, no.
10:42How mind ya?
10:43Border Terrier Charlie is marking his arrival this morning outside...
10:44...with Dad James and Mum Kay.
10:59A dog run into him about six weeks ago.
11:03It just took him out and I think it done his crucial ligament then.
11:07One-year-old Charlie is struggling to put any weight on his right hind leg.
11:11Charlie had a wee accident when he was a pup.
11:14I think he broke his leg, but that self-healed.
11:17And then he took a knock playing and his back leg just went,
11:21so he's limping on that quite a lot.
11:22Oh, Charlie.
11:23Lively terrier Charlie bounded into Kay and James' life with gusto.
11:31He is definitely the character of the house.
11:35He's extremely bubbly and bouncy.
11:37Good boy.
11:39Very quickly he established his place between ten-year-old Freddie...
11:43Quiet baby, isn't he?
11:44..and his new sister, five-month-old Lily.
11:48He's going to win.
11:50Maybe Charlie's losing that. No way.
11:52Charlie is the dominant one, even though he's the middle one.
11:58Border terriers are so hyper and they can be what we call them, the terrorists.
12:06Running around, picking up the pillars and they're throwing them
12:09and it can just be bonkers.
12:12I kept saying, when's he going to grow out of this?
12:14LAUGHTER
12:15But Charlie's recent accident has meant family life has changed.
12:23There's a good boy.
12:25All right?
12:28As soon as he hurt his leg, it's a fun went out of the house.
12:32But, you know, Charlie brings that to the house.
12:34Yeah.
12:34He wasn't running around, he wasn't wanting to play with toys.
12:38He's either in pain or drowsy.
12:40And he's walking in three legs as well.
12:42Yeah.
12:43You know, he's raising that leg up.
12:45It's very, very hard to watch a dog, like, in pain.
12:49You know, it's not nice to see.
12:50And not being able to do anything for him.
12:53It's hard.
12:54Now, I know I should be unbiased, but I am completely biased
13:00because I had a bored return on myself.
13:02I know. I'm so sorry about your dog.
13:04Can I cuddle?
13:05Yeah, we've got three of these two.
13:07You've got three?
13:08Yes.
13:09He's such a good dog.
13:10I don't know.
13:14That's lovely.
13:14Now, you just walk around there.
13:16There we go. Thank you.
13:18It's fine.
13:18I'll just observe the walking while we're doing that.
13:20I'll wipe the spit out of my mouth.
13:22It's all good.
13:25It's all good.
13:27So I notice as he walks around there
13:28that he toe-touches when he's standing.
13:31Yeah.
13:32He doesn't put full weight on it.
13:33Yeah.
13:34And he's obviously in quite a lot of pain now.
13:36Good boy.
13:37If you go up here and put his head there for me.
13:39All right, down here.
13:40Yeah, that's it. All right.
13:42Dad, if you talk to him, please.
13:43Hi, Charlie.
13:44All right.
13:44Good boy.
13:45Now, unfortunately, what I'm going to do next may hurt.
13:48I apologise in advance, Charlie.
13:50OK.
13:51Good boy.
13:52OK, OK, OK, OK.
13:56Right.
13:57There's two ligaments inside the knee.
13:58They're called cruciate because they cross over.
14:01When he was a baby, he broke this growth plate.
14:05And as a result, that whole segment tilted backwards.
14:08Yeah.
14:08That did, in fact, go on to heal.
14:11And your original tibial plateau angle was that.
14:15Mm-hmm.
14:16And now your tibial plateau angle is significantly steeper.
14:22Oh.
14:22The change in the angle of the tibial joint surface has put more strain on Charlie's cranial cruciate
14:30ligament, which holds the femur in position.
14:33So, therefore, over time, and especially when the other dog bashed into him, the ligament ruptured.
14:40Oh.
14:41So, there's two things that we can do to level the tibial plateau and take that green line back to where the purple line should be.
14:51One is, you could take out a wedge and drop that down, but it would make this bone shorter.
14:57He'd have one leg shorter than the other.
14:59He would have one leg shorter than the other.
15:01He already has one leg shorter than the other because this growth plate falls prematurely.
15:06There's another procedure that you can do, which is called a tibial plateau levelling osteotomy,
15:12which is a curve is made in this plane here, and it's rotated around the centre of the joint,
15:18so you don't lose limb length, but you still alter the angle.
15:22Yeah.
15:23Sometimes we use a combination of both.
15:25However, I won't know any of that until I take some x-ray pictures.
15:28Right, OK.
15:28So, we'll do that now.
15:32Now, treat him like a prince.
15:35Look at him! Hello!
15:37CT scans will help Noel plan the surgery,
15:40and x-ray pictures will compare tibial angles on Charlie's good and bad legs.
15:45And it's not good news.
15:49It's quite steep.
15:50It is.
15:51To reduce the steep angle, Charlie will have a combination of both procedures,
15:56with the bone segments secured with a plate.
15:59There are dozens of manufacturers of plates,
16:03but with this very steep plateau angle,
16:06none of the plates is going to fit this bone exactly.
16:09So it needs to be made up?
16:10Well, we don't have to make it up, but it is an option.
16:14It's possible to physically make a plate
16:16that fits wherever you want the screw holes,
16:19wherever you want the bend, wherever you want the curve.
16:21Yes.
16:22It's going to require quite a lot of complicated planning.
16:24And the downside is K-dress and lead-only walking.
16:27OK, thank you.
16:28OK, I'll get him for you.
16:30All right, no worries.
16:31The family are hoping the best outcome will be a custom plate
16:35based on Charlie's CT scans.
16:37That good boy.
16:39But that means they'll have to wait.
16:41It's quite difficult putting everything in the hokies.
16:43We've got an R2 of these dogs at home.
16:45We can't go for the big walks.
16:47It'll just need to be like that until we get them fixed, unfortunately.
16:50Duncan and Lucinda have been coming to terms with the news
17:00that not one but both of Maine Coon Lexi's hips are degenerating.
17:06Heartbreaking, but we have concluded that the best thing for her
17:10would be doing a total hip replacement.
17:12To give up some holidays, to just have extra cuddles with her,
17:15it's definitely worth it.
17:17Lexi could be kept under general anaesthetic
17:22and Noel is free to operate straight away
17:24if the couple want to go ahead.
17:28OK, we're going to roll a goat double hip replacement.
17:31We'll make it work.
17:33I do not want you to feel pressured.
17:35No, I think we agree.
17:37It seems to me that the left is more painful.
17:39Yes.
17:40So...
17:40Yeah, I think so.
17:41We'll start with the left.
17:42Yeah.
17:44Thanks, Doc. Appreciate it.
17:45We are doing the left. Let's go.
17:47We've just had the go-ahead.
17:50The team prepare Lexi for the first of her double hip surgeries.
17:55Epidural went in nicely?
17:57Of course it did.
17:58Let's go to theatre.
18:01Small gilpies.
18:02Noel is going to replace the old femoral head and neck
18:07in Lexi's hip joint with new metal components
18:09and the socket with a plastic cup.
18:14He starts by getting rid of the damaged head and neck.
18:18Take care of it.
18:19Then drills out the existing hip socket into the marrow behind.
18:24Flush.
18:27Before pouring in bone cement to hold the new plastic cup.
18:32The important thing is not to get any blood around the cup
18:34between the cement and the cup
18:36or indeed between the cement and the bond.
18:39And it requires me to press the cup in at exactly the right time
18:43so that the cement is not too liquid and not too hard.
18:47You only get one chance at this.
18:49It's vital that it's in the right spot.
18:52All right, load it.
18:55Next, Noel prepares the femur for the new head and neck,
18:59drilling down into the femoral canal
19:01where he will place more cement.
19:03As you can see, it's beginning to ooze out.
19:06So I'm putting my finger on there to prevent air bubbles.
19:10Once the cement is the perfect consistency,
19:13Noel inserts a metal stem into the femur.
19:16Give me the impactor, please. Thank you.
19:20After attaching the metal ball,
19:22the femur is repositioned in alignment with the new plastic cup.
19:27There we go.
19:29Feels secure. That's good.
19:30So we leave it there, one side down.
19:35If the operation's a success,
19:37Lexi will have the procedure repeated on her right hip.
19:40All right, Lexi, well done.
19:42Let's go to X-ray, please.
19:43But she'll have to make a good recovery first.
19:53The team at Fitzpatrick Referrals
19:56deal mainly with cats and dogs.
19:57But occasionally, a smaller four-legged friend
20:02makes an appearance.
20:03This is adorable.
20:05We really enjoy seeing patients
20:06that we might not get to see too often,
20:08like ferrets and rabbits.
20:09Oh, my goodness, the paws!
20:10They're so small!
20:12Word gets around very quickly
20:14and people get quite excited.
20:15Too, too tiny feet.
20:17Anything that's small,
20:18anything that's fluffy,
20:19get a lot of attention.
20:21I think he looks cute in his blanket
20:22with his fish sock.
20:23Today, it's a rabbit
20:25that's got the team in it is.
20:27I don't want to eat my oxygen.
20:29Two-year-old Lockie
20:30is being X-rayed
20:32for a suspected broken leg.
20:34It's quite big.
20:35He's 5.2 kilograms of bun bun.
20:40Oh, that's your flower!
20:42Hello!
20:44Hefty dwarf-lop rabbit Lockie
20:46lives with Dad Jake,
20:48Mum Laura,
20:49nine-year-old Louie
20:50and six-year-old Millie.
20:53Whenever we have people come over,
20:54we get a lot of
20:55how he's so big,
20:56didn't realise rabbits
20:56could be that big,
20:57that sort of thing,
20:58and he likes the attention.
20:59Lockie's about the size
21:01of an average cat.
21:02He is quite big.
21:04The kids insisted
21:05that they wanted to get a rabbit.
21:07That then turned into
21:08getting a rabbit each.
21:10We were told
21:11we were getting two boys.
21:13Lockie was a boy, as planned,
21:14and Lockie wasn't,
21:16and we ended up with 18.
21:17Lockie's definitely
21:20the leader
21:21of our rabbit family.
21:23We have his children,
21:24Benji, Kinder, Nibbles.
21:26Cucumber!
21:27Lockie is grumpy,
21:29super stubborn.
21:30Get down.
21:31He definitely has
21:32a bit of a naughty streak.
21:34Yeah, you're definitely
21:35going to rip that to shreds,
21:36aren't you?
21:36Lockie and Millie
21:37have always had
21:38a close relationship.
21:40When you first meet him,
21:42he's a little bitey,
21:43but when he gets
21:45to know you,
21:47he's calm and cuddly.
21:50He shows a softer side
21:51to the kids.
21:53Definitely think
21:53he means a lot to them.
21:55Lockie and his children
21:57have free run
21:58of the entire garden.
22:00But the big boy
22:01hurt his leg
22:02when he was tucked up
22:03in his hutch.
22:05One day,
22:06I came home from school
22:08and Lockie was just
22:09in the corner.
22:10usually he just runs up
22:14to see me
22:15and I knew
22:16something was wrong.
22:17He was limping,
22:19couldn't weight bear
22:20on his paw at all.
22:22You could tell
22:22he was in a lot of pain.
22:24He wasn't eating
22:26and we couldn't really
22:28get him to cuddle.
22:30To see him hurt
22:32just makes me feel
22:34really sad.
22:35He's really important
22:36to the kids.
22:37He means a lot to us too
22:38and unfortunately
22:39we lost Lockie
22:40last year
22:41and that was really
22:43really hard on all of us
22:44and so the thought
22:45of losing Lockie
22:46it doesn't bear
22:47thinking about really.
22:48And so we just really
22:49want to get him
22:50the best treatment
22:50we can and try
22:51and make him better
22:51as quickly as we can.
22:53Our local vets
22:53did an x-ray
22:54found that he had
22:55a break just above
22:56his wrist
22:57and they said
22:58that it wasn't
22:59something they would
22:59be able to help with.
23:01So they referred us
23:03to Fitzpatrick's.
23:04It is exactly
23:08what we would
23:08expect it to be
23:09a tiny bone
23:10and a big fracture
23:12through it.
23:13Oh.
23:14And you can see
23:15the problem
23:16with fissures
23:17going up and down
23:18like lightning
23:18from the fracture site.
23:21God.
23:21So the only way
23:23that the term dwarf
23:24actually applies
23:25to this particular
23:27big guy
23:27is he's got dwarf bones.
23:30Right.
23:31Skinny, skinny,
23:32skinny, skinny, skinny.
23:33Much smaller
23:34than you would think
23:34from his size.
23:36Rabbits.
23:36They're also
23:37super fragile
23:38in the old
23:39limb department.
23:41So there are
23:42three possible outcomes.
23:45One is euthanasia.
23:46Yeah.
23:46Which I legally
23:47have to tell you
23:48is an option.
23:49Put him to sleep.
23:51One is amputation.
23:52He could cope
23:53on three legs
23:54but they find it
23:55difficult
23:55because they hop around.
23:57And the third
23:58is repair it.
23:59The problem
23:59that we have
24:00is that there
24:01are no current
24:03commercially available
24:04implants
24:04that are for rabbits.
24:06So one of the options
24:07we've looked at
24:07more recently
24:08is manufacturing
24:09a plate specific
24:10for the patient
24:11in the factory.
24:13My biggest thing
24:14with him
24:15is the recovery.
24:17Yes.
24:17It's really important
24:18to not have them
24:19away from the pack
24:19for too long.
24:20If you want to get
24:21re-socialising
24:23pretty quickly
24:23then you need
24:24the function
24:25to be very good
24:26at the end
24:26of two weeks.
24:27I've got a friend.
24:30Hello.
24:32Lockie will stay
24:33at the practice
24:34while they wait
24:34for a custom plate.
24:36But the longer
24:37he's away
24:38from his bunny family
24:39the greater
24:40the risk
24:41he will be rejected.
24:47At home
24:48in Gillingham
24:49Kay's been
24:50carefully following
24:51doctor's orders
24:52taking one year old
24:54border terrier
24:54Charlie
24:55for short walks only.
24:56Back in your cage
24:57for a little while
24:58Charlie.
24:59It's been a hard regime
25:01while he waits
25:01for his implant
25:02to be made.
25:04It's tough
25:04leaving Charlie
25:05behind when I walk
25:06the other dogs.
25:07He starts
25:10howling quite a lot.
25:12He doesn't understand
25:13why he isn't
25:14going out
25:15for a walk.
25:17He's always been
25:18such a lively dog
25:19but he's lost
25:20a bit of his personality
25:21because he's in pain.
25:23Charlie.
25:24Yeah.
25:25I can see
25:26he's getting depressed.
25:27That has affected
25:29the Phil household.
25:31Aw, is that right
25:33to see you?
25:34We just want him
25:35to have his
25:35little doggy life back.
25:36Yeah.
25:41Finally
25:42Charlie's
25:43specialised plate
25:44is ready
25:44and the knee surgery
25:46can go ahead.
25:47Hello.
25:48Hi there.
25:49Hi guys.
25:50Well, do you want
25:51to see a work of art?
25:52That's his plate.
25:54Oh, wow.
25:55Highly complex
25:56piece of kit.
25:57Let me show you
25:57how it works.
25:58Looks a bit like
25:59my car now.
26:00We've invented
26:01this plate
26:01called a frog
26:02which stands for
26:04Fitz Rotation
26:05Osteotomy Guide Plate
26:06and it's a different
26:07design
26:08for every case.
26:10Wow.
26:11Hi Charles,
26:11come on.
26:12Big cuddle front
26:12and all.
26:13Good boy.
26:14Such a good boy.
26:16Just better.
26:17Hi guys.
26:18God bless you.
26:19Good boy.
26:20Here we go.
26:21It's the man.
26:22It's like leaving
26:23a child, isn't it?
26:24No kisses.
26:28It's okay.
26:29Don't panic.
26:38Does anyone need
26:39anything from me?
26:40I have three hands.
26:41Charlie, the border terrier
26:42with a torn knee ligament
26:44is in theatre.
26:46Noel aims to reduce
26:47the steep angle
26:48at the top
26:49of his tibia
26:49with two procedures
26:51that will hopefully
26:52end his pain.
26:53Stepper.
26:58In the first procedure
26:59Noel will use
27:00a 3D printed guide
27:02to make a curved cut
27:03in the top
27:04of the tibia.
27:05Then he will drill holes
27:07to match a customised plate
27:09before rotating
27:11the joint surface
27:11to a better angle.
27:13Because the angle
27:14is still too steep
27:15a second procedure
27:17will remove
27:17a wedge of the bone
27:19and he'll use
27:19his invention
27:20the frog plate
27:21to align
27:22the three bone segments.
27:23First with non-locking screws
27:25and finally securing
27:28the repair
27:28using locking screws.
27:36Right, here we go.
27:38Go.
27:42After using a guide
27:43to cut the top
27:44of the tibia bone,
27:46Noel uses two more guides
27:48to cut the wedge.
27:57Before I take the wedge out,
27:59I'm going to rotate
28:00this top segment.
28:02He then moves
28:03the top of the tibia
28:04to the correct angle.
28:06This rotates
28:075.6 millimetres,
28:09which has converted
28:11that angle 27 degrees
28:13that way.
28:14And we're going to
28:15take a 31 degree wedge
28:18out of here
28:18to drop this down.
28:23OK.
28:24The three bone segments
28:26are aligned
28:27with Noel's
28:27innovative frog plate,
28:30designed to Charlie's
28:31exact measurements
28:32and held
28:33with temporary screws.
28:34With one single plate,
28:37we're able to address
28:40multiple deformity sites
28:42and rotate the top
28:44of the tibia
28:45into exactly the right
28:46alignment relative
28:46to the femur,
28:47whilst using the plate
28:49itself as the realignment guide.
28:52Happy with the alignment,
28:54Noel swaps temporary screws
28:56for final locking screws.
28:58All the screws
29:00are in position now.
29:02And the intricate surgery
29:03is complete.
29:06Well done, Charlie.
29:07Good boy.
29:08Hopefully,
29:09that will work out well.
29:10CT.
29:18So, I'm doing a barbecue
29:20Saturday night
29:21for the fam.
29:22You sound like
29:22you're a bit stressed
29:23about this already.
29:24Hey,
29:25today's a big day.
29:26You get to go home?
29:28Shall I get you out?
29:30I know you're
29:30going to be grumpy
29:31and I know you're
29:32going to go
29:33at that.
29:37Of course you are!
29:39Of course you are!
29:42Three days after
29:43her first hip operation,
29:45Mistress Lexi
29:46is still making
29:47her views known.
29:50Come on, sweetheart.
29:51Yes, I know.
29:52I know.
29:53I know.
29:54It's tough, isn't it?
29:55Isn't it tough?
29:56Duncan and Lucinda
30:00are keen to get
30:01Lexi back
30:02as she's left
30:03a Maine Coon-sized
30:04hole in their family.
30:06Now.
30:07Especially for
30:07little brother Levi.
30:09Are you looking
30:10forward to getting
30:10her home?
30:11Yes, it's going
30:12to be nice.
30:12Sometimes when
30:13they start playing
30:14around, you're like,
30:14oh, can't they just
30:15be quiet for a while?
30:16And now it's too quiet.
30:18In the box.
30:20Love you too.
30:21I think he misses
30:23her more than
30:23Lexi most.
30:24Lexi most probably
30:25enjoying the peace
30:26and quiet.
30:27Yeah.
30:28We're to the
30:28annoying little
30:28brother for a bit.
30:30You know what?
30:31I'm quite convinced
30:33that in a few
30:34weeks' time,
30:34you'll realise
30:35what we've all
30:36been through
30:37is all good.
30:41Now.
30:42How are you guys?
30:44Good in you?
30:44I've had the
30:45but I've also
30:49had the
30:50good to see you.
30:54The hip replacement
30:54looks good.
30:55It's very secure.
30:57She's walking on it
30:57really well.
30:59Clearly, we still
30:59have the pain
31:00associated with this
31:01one.
31:02If she's doing great,
31:03we'll crack on a
31:03week three or four
31:04and get the other
31:05one done and overlap
31:06the recoveries.
31:08Until Lexi fully
31:09recovers, her second
31:11hip operation will be
31:12on hold.
31:13Thank you very much.
31:15We really appreciate
31:16everything you've done
31:17for us.
31:18I know you do.
31:18And I have one thing
31:19to say to you
31:20before I go.
31:23To you, madam.
31:24And I'm hoping
31:25we'll get over that
31:26very soon.
31:27I love her.
31:28You know that.
31:30Bye.
31:36Affectionately known
31:37as the Fitz Ritz,
31:39every animal gets
31:40the five-star treatment
31:41when it comes to food.
31:42Curly kale, hay,
31:44muesli, banana vig.
31:45Apparently, banana
31:46favourite.
31:47While he's waiting
31:48for a plate to be
31:49designed for his
31:50broken leg,
31:51gigantic dwarf rabbit
31:53Lockie is enjoying
31:54his offerings.
31:56Cement.
31:57Oh, man, that smells
31:58amazing.
32:00Custom plates take
32:01several days to create,
32:03but the longer Lockie
32:05is away from his pack,
32:06there's a risk he'll
32:07be rejected.
32:08Knoll's engineering
32:12and manufacturing team
32:13have had to work fast.
32:16Today, we had a
32:18rushed case for Lockie
32:20who has a fractured
32:21forearm.
32:22We got the CT scans
32:24through last night,
32:25and then we've spent
32:27our morning designing
32:28a plate.
32:29There's lots of loose
32:30bone around,
32:31so you can't put any
32:32screws through here
32:33because they've got
32:33nothing to hold on to.
32:35So we've put screws
32:36below and above
32:37the fracture line,
32:38so that keeps it
32:38nice and strong
32:39in the centre
32:40where the break is.
32:41Also, when Lockie
32:43is jumping around,
32:44there'll be quite a lot
32:45of force going through
32:46this top screw here.
32:48So by extending the plate,
32:49we take away this stress
32:51and make sure that
32:52nothing will break again.
32:55It's been through
32:56three machining processes,
32:58threaded holes put in,
33:00and then this is
33:00supported with soft metal
33:02because it's such
33:03a small plate.
33:04That's now finished
33:05on the inside,
33:06so now I'll just
33:07pop it in here,
33:08and this will melt
33:08that metal off,
33:09take it off on the ends,
33:11and that'll be it done.
33:26Hi, it's Lauren.
33:28I am coming.
33:29I'll be with you
33:29in two seconds.
33:30OK, thanks.
33:31Be as quick as we can.
33:32Let's go now.
33:33The surgery is Lockie's
33:35best chance of fixing
33:36his leg and reuniting
33:38him with the pack quickly.
33:39Go, go, go, go, go.
33:4124 hours later,
33:43the plate and the team
33:44are ready to go.
33:45So it's wonderful
33:46that we can design
33:48a plate overnight
33:49and manufacture it
33:50the following day
33:51and have the plate here
33:52for surgery,
33:53which is a game changer
33:55really for patients
33:57like Lockie.
34:00Hold on.
34:00Noel puts a stabilizing pin
34:04into the Alnavo,
34:05which helps pull the broken
34:07segments of the radius
34:08into alignment.
34:11So the next thing
34:12we're going to do
34:12is see where
34:14the plate should go.
34:16The advantage
34:17of this custom plate
34:18is because it's shaped
34:19the same as the bone
34:21based on the CT scan,
34:23it hugs the bone
34:24against itself
34:25and reduces
34:27the fracture for us.
34:30The plate should hold
34:31the segments together,
34:32but the screws used
34:33to attach it
34:34are only 2mm in diameter
34:36as Lockie's bones
34:38are so tiny.
34:40One of the big problems
34:41with rabid fractures
34:42is that as you tighten
34:44the screws
34:44they can splinter
34:45because the bone
34:47is quite fragile.
34:48Yeah, that's a real problem.
35:00The problem is
35:00that this particular fissure
35:02is running down
35:02into that screw hole
35:03and it's possible
35:04that that may come
35:05right down
35:06and fracture into the joint.
35:07So I cannot put
35:08another screw
35:08into that hole there
35:09because it will
35:10destroy the bone.
35:12This is the ubiquitous
35:13problem with rabid fractures.
35:15They splinter like glass.
35:16We have a myriad
35:18more fissures
35:19than we had
35:20been able to see
35:22on the CT scan.
35:24So I'm going to have
35:25to back off
35:25at this point
35:26and leave this screw hole
35:27and this screw hole
35:27and this screw hole
35:28empty.
35:30We hope those
35:31tiny splinters
35:32will all congeal
35:33into a callus
35:34to heal
35:35that fracture.
35:37It's a big ask
35:38of the biology
35:39but I just have to hope
35:42my best is good enough.
35:44The alignment is good.
35:46So if it stays like that
35:48that will be great.
35:49Right.
35:50You in there, Lockie?
35:52Are you feeling
35:52lucky, Lockie?
36:03I can't wait to be here.
36:04I'm convenient.
36:05You're a big king
36:05of him and smiling.
36:08In reception
36:08James and Kay
36:10have arrived
36:10to collect Charlie
36:11their border terrier
36:12after his knee surgery
36:14five days ago.
36:16Good boy, Charlie.
36:17So this is what
36:18we started with
36:19which was a very large
36:21curve on the top
36:22of the tibia like so
36:23and this is what
36:25you've ended up with.
36:27Oh, wow.
36:28What a difference, huh?
36:29God, yes.
36:30The plateau
36:31has been tilted
36:32back to normal
36:33through the combination
36:34of that curved cut
36:35with the wedge
36:36osteotomy
36:37so that the femur
36:38no longer slips
36:38down that slope.
36:39Well, that's brilliant.
36:41He's out here.
36:41Hello.
36:44Hello, baby.
36:47Oh, Charlie.
36:49Oh, that's good.
36:50Wow.
36:50God, that's so neat.
36:51Well, I'll get a job
36:53as a seamstress.
36:55So, as you can see,
36:56the wound is good.
36:57You've just got to
36:58not let him run, jump,
37:00slip or slide.
37:01He can happily
37:01have ten-minute walks
37:02and when you walk him,
37:05you just ideally
37:06stoop down
37:07and grab his harness.
37:08Right, OK.
37:09OK, let's go.
37:11Thank you very much.
37:12No worries.
37:13I'll kiss him goodbye.
37:14Right, mate.
37:14Love you.
37:16Love you, mate.
37:16Love you.
37:17Love you.
37:19James and Kay
37:20have put their life
37:20on hold
37:21for the last three months
37:22dealing with Charlie's injury.
37:24But it's not over yet.
37:27The next few weeks at home
37:29will be crucial
37:30for his recovery.
37:39This should be like
37:40a second home for her right now.
37:44Five weeks ago,
37:45Queen Bee Lexi
37:46had the first
37:47of her hip operations
37:48to help her walk
37:49pain-free again.
37:50Today she's back
37:54for the second
37:56hip replacement.
37:58Lexi is full of beans
37:59so we're pretty excited
38:01for her to have
38:02her second hip
38:02so she can get back
38:03to normal.
38:04Hi, guys.
38:05Hello.
38:07How you doing, baby?
38:08You all right?
38:09So good on the hip
38:10we've already done, right?
38:11Yes.
38:12She's been trying
38:13to run in the cage.
38:15Playing with anything
38:16and everything she can.
38:17Yes.
38:18I know, sweetheart.
38:19I know.
38:20It's okay.
38:21It's all right.
38:22You're with uncle.
38:23No, it's fine.
38:24Yeah, I know.
38:25I know.
38:25I've heard it all before.
38:27I've heard it all before.
38:28You know I have.
38:29Good.
38:30So the second one today.
38:32You know the score.
38:33You've been through it before.
38:34Lexi will now have
38:36her other hip joint replaced.
38:39The neck of the femur
38:40has degenerated
38:41even further
38:42over the last few months.
38:44I've just had a look
38:45at the x-ray pictures
38:46and this hip's
38:48in a very bad way.
38:49The femoral neck
38:50has wasted away
38:51even more
38:51due to lack of blood supply,
38:53so-called avascular necrosis,
38:56which is sadly
38:56a genetic problem.
38:58Right, go me, please.
38:59So hopefully we can get Lexi
39:01permanently out of pain.
39:04And into a situation
39:05of good function
39:05after this hip replacement.
39:08All right, let's go.
39:09The first one
39:10was really, really scary.
39:12And I guess you're
39:12getting through
39:13the second one
39:14and making sure
39:14that everything's fine
39:15and she fully recovers.
39:17So it's quite a big
39:18emotional rollercoaster.
39:34What have we here?
39:36Hey, mate.
39:37How you doing?
39:37I've got some salad
39:38for you, mate.
39:40It's been three days
39:41since enormous dwarf rabbit
39:43Lockie had a custom plate
39:44fitted to fix
39:45his broken leg.
39:46Here you go.
39:47But he's not a happy bunny.
39:50Have you got the hump?
39:50Because I examined your leg.
39:52Is that what it is?
39:53Yeah, I think you might have.
39:54And if I get a dandelion
39:56with a longer stem...
39:57Any interest?
39:59Oh, yeah.
39:59Oh, yeah.
40:00I'll have that.
40:00Thank you very much.
40:02Today, Laura's back
40:03to pick up
40:04her giant fluffy bundle.
40:06I've heard he's been
40:07a bit of a character.
40:08He's a bit of a diva.
40:10But I think he's had
40:11a nice time.
40:12Home time, mate.
40:13Home time.
40:16Hi, Noel.
40:16Come on in.
40:17Oh, my goodness.
40:18Little card.
40:19Yeah, my daughter's
40:19made you a card.
40:20Oh, my God.
40:20That's beautiful.
40:21Oh, this is gorgeous.
40:23And how old is Millie?
40:24She's six.
40:25She's so grateful.
40:26It's her rabbit.
40:27I mean, that's awesome.
40:28I can't even draw
40:29a rabbit that good.
40:31Anyway, this is
40:32what we started with,
40:34as you know.
40:34Oh, he's poorly.
40:35This is what you have now.
40:37Oh, look at his little plate.
40:39Bionic rabbit.
40:40Yeah, but because
40:41of the multiple fissures
40:42here, I couldn't put
40:43a screw there
40:44or there or there
40:45because it was going
40:46to fracture the bone more.
40:47It's too weak there.
40:48That's right.
40:49But fortunately,
40:51this is a beautifully
40:51strong plate.
40:53So even though
40:54there are holes
40:54in the middle,
40:55I don't think
40:56that they will be
40:57dramatic stress risers.
40:59Yeah.
41:00Now, all this
41:01needs to heal in.
41:02All the exploded bits
41:03that need to congeal
41:05in a callus
41:06and you've got to
41:07not let him
41:08accelerate
41:08or jump about
41:09because if it does,
41:12these fissures
41:13will go down
41:14into those screws
41:14and it'll explode
41:15and it'll explode
41:15into his wrist.
41:16Okay.
41:16So that's why
41:18it's very necessary
41:19to keep him
41:20in his hutch.
41:21Complete cage rest.
41:22Complete cage rest
41:23at all times.
41:24He's an interesting
41:25character
41:26and sometimes
41:26he's fine.
41:27He's like,
41:27all right,
41:28serve me from
41:28the rabbit salad
41:31platter, please.
41:32Yeah, hand feed me.
41:33Hand feed me.
41:34Yeah.
41:34And he doesn't like
41:35the dandelion
41:35with just a head.
41:36He wants me to hand it
41:37to him on the stem
41:38so that he can...
41:39He nipples all the way up.
41:40That's right.
41:40Yeah, I can totally
41:41picture it.
41:42Whoa.
41:43Oh, bum to the door.
41:44Yeah.
41:46Hi.
41:47I am feeling
41:48the pressure
41:48for the next six weeks.
41:49Yeah, well, I can imagine.
41:50He doesn't move
41:51off the spot.
41:51Yeah, yeah, yeah.
41:51Well, as long as
41:53he's in his hutch,
41:53you're good.
41:55Thank Millie so much.
41:56To be accepted
41:58back at home
41:58in his rabbit pack,
42:00Lockie needs to make
42:01a good recovery
42:02without any setbacks.
42:04Right, so you know
42:05the rules.
42:05Yeah.
42:06Anything else?
42:06No, I don't think so.
42:08He's got the right hump.
42:09He gets the hump
42:10and then he turns
42:10his rump towards you
42:12when he gets the hump.
42:12It's called
42:13the Lockie Rump Hump.
42:14Yeah, the Lockie Rump Hump.
42:18Hi, darling.
42:20I can't believe
42:21the size of him.
42:22He's bigger than my cat.
42:23Are you all right?
42:24Yeah, I'm going to
42:25try and keep him dead still.
42:28He's definitely
42:29not out of the woods yet.
42:31He's not allowed
42:32to move really at all
42:33for the next six weeks.
42:34So, really apprehensive
42:36about that.
42:48Lockie is gradually
42:49finding his feet
42:50back with his family.
42:53The first week or so
42:53after the operation
42:54was really difficult
42:56because Lockie
42:57had to be away
42:57from the rest of the rabbits.
42:58We had to keep him isolated
42:59and he wasn't really
43:00allowed to move too much.
43:02So, that was quite tough.
43:03But, it was definitely
43:04worth going through that
43:05to see him happy
43:06and well again.
43:07He's back,
43:08living outside,
43:10hopping around.
43:11I feel happy
43:12that his leg
43:13is all better
43:15and now I can
43:16snuggle with him.
43:18We get to do that again.
43:20Lockie has been
43:21reintroduced gradually
43:23back with his children
43:24as rabbits can be
43:25territorial
43:26if one leaves the pack.
43:27We're still working
43:28on him
43:29integrating back in
43:30with the rest
43:30of the rabbits.
43:31We're getting there.
43:33I feel happy
43:33that he's home.
43:35The other rabbits
43:36are still young
43:37and they need
43:39Lockie
43:39to protect them.
43:41He's a big part
43:41of the family
43:42and we're really
43:43pleased that he's
43:44on the mend.
43:45Lockie has been
43:46special since we
43:47got him.
43:48He's just been
43:49getting specialer,
43:50really.
43:50It's been five months
43:59since Charlie
43:59had his
44:00groundbreaking knee
44:01surgery.
44:03Charlie, come on.
44:04Come on, Charlie.
44:05James and Kay
44:06have worked hard
44:07for months
44:08to help his recovery.
44:09Good boy.
44:10Come on.
44:11Come on.
44:12Come on, Charlie.
44:13Come on, Charlie.
44:15Go get a ball.
44:16He's nearly
44:16back to normal now.
44:18Yeah.
44:18Which is really
44:19good to see.
44:20Charlie.
44:20Get a ball.
44:21What's this?
44:22Swimming's been
44:23brilliant for him.
44:25Good for his leg.
44:26Charlie.
44:28Come on.
44:30What a good boy
44:31you are.
44:32What a good boy.
44:34Where's your ball?
44:35Get a ball.
44:36It's a relief
44:37to get him out
44:37of the cage,
44:38to not worry
44:39about if he's
44:40going to hurt
44:41his foot,
44:42all the worrying
44:43about the physio.
44:44Feels like
44:45we're just
44:45free up.
44:46It's been great
44:50to see Charlie
44:51getting his
44:52personality back,
44:53starting to
44:54chase the ball,
44:55run about
44:55and just be
44:56really happy.
44:57It melts your
44:58heart to see him
44:59all running
45:00and playing.
45:01We've got a wee
45:02family back.
45:03We're happy again,
45:03aren't we?
45:04Red.
45:04Go, go, go.
45:05Go, go.
45:05Go, go.
45:06Go, go.
45:06Go, go.
45:06Go, go.
45:07Go, go.
45:07Go, go.
45:08Go, go.
45:08Go, go.
45:09Go, go, go.
45:09Go, go, go.
45:10Go, go, go.
45:10Go, go, go, go.
45:11Go, go, go, go.
45:12After her two hip
45:21replacements,
45:22Maine Coon Lexi
45:23is back to her
45:25feisty feline self.
45:27It's back to normal.
45:28It's almost like
45:29the operation
45:30didn't happen.
45:31She's been
45:32running around
45:33in the house,
45:34jumping on the
45:35couch,
45:35jumping on the
45:36table,
45:37chasing her
45:37brother,
45:38everything that
45:39she always did
45:39before her
45:40injury.
45:41Since Lexi
45:42wasn't around,
45:43Levi was kind
45:44of subdued
45:45in many ways
45:45and I think
45:46he's enjoying
45:47playing with
45:48Lexi again.
45:50And she's
45:50quickly re-established
45:52the pecking order.
45:54She's been
45:54back to the
45:55normal lovable
45:55self,
45:56purring when
45:57we pick her
45:57up,
45:59calling us
45:59when we need
46:00to come and
46:00give her some
46:01food if she
46:01already had
46:02breakfast.
46:03And still
46:04the boss of
46:05the house
46:05as she used
46:05to be.
46:06Being able
46:07to hold her
46:07without hurting
46:08her and her
46:10hissing at
46:10us is just
46:11one of the
46:12most amazing
46:12things for me
46:13personally.
46:14It's just
46:15nice seeing
46:15that she is
46:16back to her
46:17old self
46:17and her
46:18cuddly self
46:19and always
46:20just wants
46:20to give so
46:21much love
46:22out.
46:22So I'm
46:23very happy.
46:40as you
46:42to make
46:44forget to
46:45get
46:45that she
46:45got
46:45done.
46:46So I'm
46:47going to get
46:48one of the
46:48stories.
46:49I'm
46:50going to get
46:51one of the
46:51bigoline
46:51and also
46:51counting on
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