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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! Yes!
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. Well done.
01:05Staff at Fitzpatrick referrals are no strangers to people who want to do their very best for their animals.
01:12Families will just go to extraordinary lengths for their pets.
01:16They are so dedicated.
01:18Some people, they'll travel massive distances just to try and get the best or the only treatment they can.
01:25Arriving today are devoted pet parents Rob and Mel.
01:31They've driven five hours from Cornwall with their six-month-old Bouvier de Flanders, Coa, who has a badly deformed front right leg.
01:40We have a dog that's broken.
01:42He'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.
01:54He is everything to us.
01:58And I can't say much more because I can feel my voice going and I shall cry again.
02:09Mel and Rob live in Newquay where there are no less than 15 sandy beaches.
02:15Paradise for any dog walker.
02:17But then...
02:18We've always owned dogs.
02:21Come on, cuddle.
02:22We love Coa.
02:23He's our second Bouvier.
02:26Coa is great fun.
02:28He'd have his dinner and then he'd stand in his dish looking out the window.
02:33He is a fur baby.
02:35When I was grooming him one day, I thought his leg didn't feel right.
02:41I 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.
02:54Coa's in a lot of pain.
02:58He can't fetch.
03:00He can't run around.
03:01He can't jump.
03:02Coa can't be a puppy.
03:04Seeing Noel is his last chance.
03:11Noel has already assessed Coa and had scans and x-ray pictures taken of his leg.
03:18This poor dog has grown quite fast, which is the nature of this breed.
03:24Therefore, deformity happens at an early age because these two bones grow at an absolute rate of knots.
03:31And if we look at the CT scans, you'll see there's a massive banana shape here.
03:38You've got a deformity which is forcing the foot in a completely different plane.
03:44Now, when something is curved, twisted and translated, then our life gets very, very difficult indeed from the correctional point of view.
03:55And it's because this bone stops growing and acts like a bow string and this one keeps growing and acts like a bow.
04:05It's actually quite rare to see one this bad.
04:08The wrist is probably like 90 degrees like a flipper.
04:11Oh, my God.
04:12The other problem, of course, is that one leg is dramatically shorter than the other and getting worse every day.
04:18The options are, continual medical management I did not feel was a good option.
04:23No, not fair.
04:24Taking the leg off is absolutely an option or do major surgery.
04:29But the surgical procedure is complex as the leg not only needs to be straightened but also lengthened.
04:36All 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.
04:43And I'm going to have to cut it here to get that bit back to there to somehow make that straight.
04:49Make it cut in the middle, rotate it a bit and then you want to grow in the middle.
04:54Right.
04:55Do you understand?
04:56Yeah.
04:57But legally I'm obliged to tell you before we do any surgery that euthanasia is an option.
05:02Yeah.
05:03If he was miserable and unhappy and not interested in life, completely different.
05:12I think we need to give him the option to have surgery to fix it.
05:22You 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.
05:32We would never do it just for you.
05:34No.
05:35No.
05:36And we would never do it just for ourselves.
05:38My 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.
05:46My stomach is in knots.
05:48Yeah.
05:49We just need to try for him.
06:03Seven miles down the road is Knowles Guildford Hospital.
06:07The centre specialises in oncology and soft tissue surgery.
06:11Hi, sweetie.
06:13Arriving today is Patricia with her 11-year-old Rhodesian Ridgeback, Kwanda.
06:20That's right.
06:21We 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.
06:34And 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.
06:42Patricia lives in Chobham, Surrey, but Kwanda's not her only companion.
06:49I've got six dogs.
06:51They're my family, my kids.
06:54They are the whole of my life, actually.
06:57I've had Kwanda, so she popped out of her mother as a little puppy.
07:02Kwanda is my favourite because she's a very polite little girl, doesn't give offence to anybody.
07:07And she's a nice little girl.
07:11But last month, Patricia noticed the worrying swelling in Kwanda's eye.
07:16My vet thinks that it probably is cancer.
07:20Having had cancer myself, I know you can get through it.
07:23And if you catch it fast enough, as mine was, then you're on a winner.
07:31And even if she's only one-eyed, if I've got my nice, happy Kwanda back, then I shall be as happy as Larry.
07:39Kwanda will be examined by senior clinician Dr. Laurent Finji.
07:47Come on in.
07:48That's a good girl.
07:49Come in.
07:50Hello.
07:51Hello.
07:52Thank you again for fitting us in today.
07:54That's it.
07:55It's supersonic.
07:56Oh, don't worry.
07:57I'm not going to trouble you too much.
07:59Just having a quick look.
08:00That's it.
08:01All right.
08:02You can actually see the little bulging there.
08:09Yeah.
08:10OK.
08:11That's good.
08:12All right.
08:13So I think either it's infectious.
08:15Yes.
08:16Like an abscess can happen.
08:17Could be a tooth problem.
08:19It could also be a tumour.
08:22We have specialists in imaging here.
08:24So we'll see also if she has any obvious other problems or anything like that.
08:28Yes.
08:29That's it.
08:30If you will for me, please.
08:31I brought her into the world.
08:32So I don't know that I want to lose her yet.
08:34Do your best.
08:35We'll do our best.
08:36But she's got to have a quality of life.
08:37That's the bottom line with mine.
08:39All right.
08:40All good.
08:42Oh, no.
08:43Thank you very much.
08:44All right.
08:45Let's go big girl.
08:46Good girl.
08:47Good girl.
08:48Look at that.
08:49Don't worry.
08:52Good girl.
08:53Because she's special.
08:55She's the last of a line.
08:58So I hope.
09:02Yeah.
09:03No.
09:04It'll go well.
09:05It'll go well.
09:11Straight away, Laurent can see what's wrong.
09:15This is not looking like an abscess at all.
09:18It looks like it's a tumour.
09:21It's a bit disappointing that it's not an abscess.
09:23An abscess, obviously, is completely curable,
09:27whereas this tumour, for the moment, we don't know if it is.
09:31The only way to find out how serious the tumour may be
09:35is to take a biopsy and send a sample to the lab for testing.
09:40So we submit that to our pathology lab.
09:44They will tell us, they will confirm that it's a tumour,
09:47and hopefully being able to tell us what type it is
09:50and how aggressive it is.
09:52Laurel updates Patricia.
09:55You ready for me? I'm through.
09:58So this is the eye that's normal, and it's in a normal position.
10:03Yes.
10:04And that's the eye that's been pushed out,
10:06and you see how much it's been pushed out,
10:08and it's been pushed out by this big thing here.
10:11And you see where it's pushing a little bit in the mouth.
10:13Look at that.
10:14And this is how the eye is pushed out.
10:15Really pushed out of place.
10:16Exactly. And just by this mass again.
10:17Okay.
10:18What I don't know is if we could spare the eye or not.
10:20If you see here, it's very much in contact with the eye.
10:23Yes.
10:24One, two, three.
10:27I've asked for the pathology results to come urgently.
10:31So it still needs time to be processed.
10:32Yes.
10:33It needs to be sent to the lab and processed.
10:34She'd be better off having an eye missing.
10:37Yes.
10:38But who knows if she sees very well in this eye at the moment anyway.
10:41Well, at the moment, the way it is, she's not happy.
10:43It might be easier for her to learn to do without it.
10:46Sometimes it's better to do without.
10:47So one step at a time.
10:48Yes.
10:49Let's wait for the results from pathology and we'll see from there.
10:50Yes.
10:51Let's see.
10:52That's it.
10:53Okay.
10:54Yeah.
10:55Oh, here's my Quandah, you see.
10:56Here's my little old lady.
10:58Wait till you smell my car.
10:59It's got chicken in it.
11:00Nothing more can be done for Quandah until the results are back from the lab.
11:05The worst case scenario would be that she spends a long time in here with me not knowing
11:12whether or not I'm going to lose her.
11:14For me, cancer is the killer.
11:17So it's got to be removed and sorted.
11:21It's mid-afternoon.
11:27Mel and Rob are back to see Noel so that he can take a closer look at six-month-old Coa's
11:33bowing front right leg.
11:35So now you can see this three-dimensional deformity I'm talking about.
11:38That's the banana there at the back.
11:40See that?
11:41Yeah.
11:42The radial carpal bone is here and it should be straight under the radius.
11:45See, even under that deep sedation it hurts.
11:48Oh, Jesus.
11:49Stay there.
11:51Yeah, good.
11:52All right.
11:53Wake him up.
11:54I want to see him walk on this leg.
11:55Let's go.
11:58So straight up and down again now that the leg's shaved, that will help me out.
12:01Keep going.
12:02You're not with it, are you?
12:03Look, you're all calm now.
12:04OK, we can see it now, can't we?
12:05Look at that.
12:06There's a compensation.
12:07The elbow's going out, the wrist is going in.
12:09It's a big deal, this.
12:10This is not a small undertaking.
12:12It's a massive big deal and we may fail.
12:15Coa's surgery will be complicated.
12:18Noel will need to create plastic 3D models and plan the operation very carefully.
12:23Looking at that leg, you think, Jesus, that is a mess.
12:28Some people would say, oh, just put him down.
12:31But you can't do that when there's a chance.
12:35I would regret it.
12:37Here we are.
12:38You come with...
12:39Pssh, pssh, pssh.
12:40Oh, kisses.
12:41Oh, bless her.
12:42It's Patrick of Ferris, Orthopaedic Cineology, Natalie speaking.
12:44Can I help?
12:46Oh, kisses. Oh, bless her.
12:54It's Patrick of Ferris, orthopaedic cardiology, Natalie speaking. Can I help?
12:59It's mid-morning and Jane has arrived with her son Ian and her seven-and-a-half-year-old crossbreed, Cleo.
13:07Cleo has struggled with pain in her back leg for years and previous surgery has failed.
13:13She's had her right hip replaced twice, but that one's only lasted about a year and she's now very seriously lame.
13:22Right, Cleo's mummy, please, Cleo's mummy.
13:26What's the symptoms? It just...
13:29She's hopping and lame. Seriously, you can see she's lame on both legs in actual fact, but the right one seems to be the worst.
13:37Right, let's have a look.
13:39Good girl. All right, good girl. Steady, steady, steady.
13:43She will go rigid with fear.
13:45She is painful, aren't she? I know she is.
13:48All right, super.
13:50OK, all right.
13:51She's slobbering now.
13:53Yeah, well, because she's very brave, she's just slobbering when the pain happens rather than, you know, being aggressive or anything else.
14:01She won't show you. Sure.
14:02Jane lives in Hampshire, surrounded by animals.
14:10My love of animals started from childhood, really.
14:13Well, we have three rescue dogs, four horses, and we encourage our wildlife here.
14:20Jane took Cleo in as a rescue dog when she was just a year old.
14:24We wanted to get another dog.
14:26We didn't go and look.
14:28We asked for a dog that might find it hard to get a place.
14:32They gave us Cleo.
14:34Cleo is a real live wire.
14:38I love her personality.
14:39If you like a dog that's lively and gives everything, you would like Cleo.
14:49But three years ago, Cleo developed hip problems, and she's still suffering.
14:56She's had two hip replacements, and this, sadly, over time has gone wrong.
15:03I know that it's bad, but I don't know to what level it's bad.
15:07She just needs, her just needs, an operation so she can live a life.
15:16Just to see her run again and enjoy it would be lovely.
15:21If Noel's able to fix her, it would be tremendous.
15:26Noel has sent Cleo for a scan to get a better idea of the state of her hip and the current implant.
15:32Failed hip replacements can cause severe bone loss, affecting the hip socket and femur,
15:40which means repeated surgery becomes increasingly difficult.
15:43On the x-ray picture, you can see there's a bolus of cement around the cup,
15:49but you can see on the CT scan that there's a lucent line between the cement and the rest of the bone,
15:54meaning that that cement is moving in the bone.
15:57It's not bonded.
15:59In addition to that, the femur's in big trouble.
16:02This wall of the femur is crumbling.
16:09It's a hip replacement that has gone wrong.
16:12Very wrong.
16:13Yeah.
16:14She coped with all of that.
16:17Do you know, she's always been happy.
16:20The bottom line is that revision's very complex.
16:23Leaving her as she is is not a great option.
16:25No, no.
16:26Taking off the leg is possible, obviously, and is an option,
16:31but the challenge is that the other hip is really bad.
16:34I know it is.
16:35So what would you do?
16:36Well, what I'm thinking is that we would have to put something there to shore it up.
16:43Now, whether we could put a partial half a femur in there
16:48and somehow screw it on to what's left of the outside.
16:54The socket side, I would engineer a revision cup for that somehow.
17:05And also, I'm morally bound to tell you that whatever I do could fail.
17:11Can't leave it as it is, and I just want it as strong as I can get it.
17:17Come on, Baba.
17:17Come on.
17:19Hello.
17:20Noel needs to create a bespoke implant to reconstruct Cleo's hip joint
17:24and reinforce her decaying bone.
17:28Amputation is an option, but she has arthritis in her other hip.
17:32There's the possibility of the leg being removed,
17:34but obviously I'd rather not because the other hip is not very good,
17:37but I don't want to lose her.
17:39So that would be the last option, really.
17:43But he's still thinking along the lines of being able to repair that one.
17:47Today, Mel and Rob have brought six-month-old puppy Koa back to Fitzpatrick's for her complex surgery.
18:05Koa is unable to run around like other puppies due to a deformed front right leg, which is also too short.
18:12The options we started off were not good, but we decided to give him the best bet we could do.
18:21I'm trying not to show that I'm very emotional about it and I could cry at any minute.
18:28Ultimately, if it doesn't go right, he'll lose his leg.
18:32Surgery is just the start for Koa.
18:37Once it's completed, Noel will begin the gradual process of lengthening his leg.
18:42Yeah, no worries.
18:44As this will take several weeks and he's so far from home,
18:47Koa will remain at the practice for daily monitoring.
18:50The surgery's a big deal, you know?
18:52Yeah.
18:53And it's quite a painful thing to do,
18:56so he's going to need to be on heavy-duty painkillers for the time being.
18:59Right.
19:01But he looks like he's looking forward to it.
19:03Well, I doubt that very much, but we will do our very, very, very best.
19:07All right, good.
19:08Let's go with Laura.
19:09Let's go through.
19:09Big cuddles, Mum.
19:10OK.
19:12There you go.
19:13See you later, mate.
19:13See you.
19:14All right, big fella.
19:15Please be good.
19:16Good boy.
19:17Please be good.
19:17Good boy.
19:18Right.
19:18I'll do my very best.
19:19Good.
19:20Mel and Rob will return to Cornwall,
19:22and because of the distance,
19:25they won't see Koa again until his treatment is complete.
19:29Right.
19:29It's just scary not knowing it is,
19:33and it's going to be the longest day for a while, I think.
19:39This is the start of it, really.
19:41Very apprehensive, because anything could happen.
19:43Koa has been anaesthetised and clipped.
19:51We can see here how deformed the right front leg is by comparison with the left.
19:55There's a massive bow on it in all directions.
19:58This is going to be a massive challenge.
20:00To straighten Koa's leg,
20:05Noel will drill out the wrist cartilage,
20:07cut some of the tendons,
20:08and rotate the foot back into alignment with the elbow.
20:12Both forearm bones will be cut.
20:15Noel will rotate the twisted radius to make it straight.
20:19The forearm bones will then be secured to rings and wires
20:22to make a specialist expanding frame,
20:25which will gradually lengthen Koa's leg as it heals,
20:29a technique known as distraction osteogenesis.
20:32Finally, he will fuse the wrist solid in the correct position,
20:37using pins attached to the base of the frame.
20:41It's just before 8pm.
20:44Noel's already opened up Koa's forearm
20:46and cracked the short ulnar bone that was causing the radius to bow.
20:50What we've done is we've removed the bowstring effect of the ulna.
20:55Next, Noel opens up the wrist.
20:59It should be exactly straight,
21:00but it's curving that way, pushing the foot that way.
21:03As a result, the wrist is deformed.
21:06Poor little fella.
21:09Noel drills out the cartilage from each wrist bone
21:12and cuts the tendon,
21:15which is stopping him pulling it back into alignment with the leg.
21:18The wrist is all floppy now.
21:21You can move around in any direction.
21:23We can pull the wrist back into a more or less straight alignment,
21:26as you can see.
21:28Noel then turns his attention to straightening Koa's forearm.
21:32So you have to cut it by drilling it and then splitting it.
21:35We can't cut it with a saw.
21:36If you cut it with a saw, the heat will kill the cells.
21:38If the cells die,
21:40the bone won't be able to grow once it's been straightened.
21:43OK, so just crack the radius in half there.
21:48And you can now see that I can grab the elbow and the wrist
21:53and just rotate that right around like so.
21:56With the leg held straight,
21:58he attaches a frame with wires and rings
22:00that will hold the bone segments in the correct position.
22:03The frame will make the bones longer
22:09by gradually pulling the segments apart at the break points,
22:13which encourages new bone to grow between them.
22:17I'm going to make it grow by turning this dice here.
22:20Every time I turn from one to two,
22:24that pulls this apart one quarter of a millimetre.
22:27And we're going to make new bone right here,
22:31make this bone longer.
22:35Finally, Noel skewers the wrist with larger pins so it is straight,
22:40extends the frame to hold these pins in position
22:44and adds bone graft.
22:48And that should act as a scaffolding
22:49for the bone to grow in between the wrist and the radius.
22:52He stitches up Koa's leg
22:57and finally, after five hours,
23:00the operation is complete.
23:02Well done.
23:05Hi, Melanie. It's Noel here.
23:06Hi, Noel.
23:06As if anyone else will be ringing at 1am.
23:09Yeah, true.
23:11OK, so I've done the operation.
23:13As you might expect, it was very challenging.
23:15Is he comfortable now?
23:17He is zonked.
23:20Oh, I do.
23:21He's not going to know anything for the next 48 hours.
23:24Thank you for believing in him.
23:26He's a lovely chap.
23:27Thank you. Bye.
23:30Oh, man.
23:41It's a week since Kwanda the Ridgeback
23:44came to Noel's Guildford Hospital
23:46for tests on a lump behind her eye,
23:49and Patricia has had the results.
23:51It's a cancerous growth,
23:54and it also goes all the way down
23:56in that bone socket to her jaw.
24:00I remember when they said it to me,
24:03I'm sorry to say, but you've got cancer.
24:05That's when it takes the wind out of your sail,
24:07and I found myself crying
24:08as if I was a two-year-old.
24:10Today, Patricia's also brought Kwanda's sister, Amira,
24:15as a potential blood donor.
24:19That's it.
24:19That's it. Thank you.
24:21We're going to have to remove some bone
24:27to access the tumour first,
24:30so some of the cheekbone here,
24:32some of the upper jaw,
24:34maybe a little bit of the lower jaw as well.
24:37Regarding the eye, actually,
24:38if we find that we have any adhesions
24:41of the tumour
24:42that will compromise the function of the eye,
24:44then we might have to remove the eye.
24:47Yes, that's fine.
24:49All right, you going to stay with us?
24:50I'll see you soon.
24:51You'll be good.
24:52It's going to be all right, so...
24:54Perfect.
24:54I think it's going to be a long day.
25:00Even when they tell me they start,
25:01I think I'm going to be looking at five to six hours
25:04before I hear it again.
25:06That's a whole day.
25:08It's going to be hard.
25:09Yeah, leave, yeah.
25:14You can actually see inside the mouth here
25:17that you have this little lump here
25:22as part of the tumour, this.
25:24So we're going to approach the tumour from the mouth
25:27to be able to do a cut here.
25:29And we're going to do another cut just under the eye here
25:32to be able to approach from a lateral aspect as well.
25:35So we'll have to remove some bone to access the tumour.
25:38Hopefully we can then resect the tumour and reconstruct.
25:41Laurent first needs to remove the lymph nodes in Kwanda's neck
25:46so they can be sent to pathology for testing
25:49to find out if the cancer has spread.
25:53There it is. Nice.
25:55Yeah, we're good.
25:56So you can see, it was big enough to actually try to hit me.
26:02He now needs to remove the tumour.
26:06We're going to make a much bigger smile,
26:08a kind of a joker smile.
26:13He cuts out part of the jaw
26:15and cuts into Kwanda's cheekbone.
26:17So all this is the tumour,
26:20this big bulge there.
26:22So that's good.
26:23That's the eye.
26:25And the tumour is not adherent to it.
26:28This means there is a greater chance
26:30that Laurent may be able to save Kwanda's eye.
26:33We'll have to be cautious not to have the eye drop in too much
26:36because there'll be such a hole.
26:39If the eye pops out, we'll put it back.
26:42Laurent begins to cut out the tumour.
26:45He needs to take it all out
26:47if he is to stand a chance of completely removing the cancer.
26:53That's it.
26:54That's the whole tumour.
26:55So far, so good.
27:01We have a pretty big hole in the mouth
27:03that's leading into the old bit there.
27:07This is where the tumour was.
27:09Not only has Laurent managed to remove all of the tumour,
27:13he's also managed to save Kwanda's right eye.
27:16He's now able to perform careful reconstruction surgery on her face.
27:21Look at that, the eye is back in position.
27:27Good.
27:28Hopefully she'll feel good.
27:30She should see better.
27:32But hopefully she'll soon
27:33well be back to being completely normal.
27:40Kwanda will need to recover from surgery
27:43and await the results of the lymph nodes test
27:46to see if the cancer has spread.
27:48It's midday
28:09and Jane is back with Cleo the rescue dog.
28:13Today, Cleo is having surgery
28:15to replace her failed right hip implant.
28:18But her hip is in such a bad way,
28:20success is far from guaranteed.
28:23I know that she could lose her leg.
28:26And when you've put her through it
28:28two other occasions,
28:30it is worrying.
28:33It really is worrying.
28:35I know it's got to be done.
28:38I'm worried.
28:39Jane has brought her eldest son, Simon, in for support.
28:52Simon, how are you?
28:54Hello.
28:55How are you again?
28:56Fine, thank you.
28:57Have a seat.
28:58Oh, good.
28:58Because of Cleo's crumbling hip joint,
29:01Noel has had to design a groundbreaking custom implant.
29:04So I've made a mesh out of trabecular metal,
29:09which is like a half a barrel.
29:11And that half barrel is going to go in that position there.
29:18Down the side of the bone,
29:20we're going to put this very complex plate.
29:22So this is going to go up over the top of that.
29:26So that takes the load from that piece of exposed bone
29:30all the way down to solid bone, down to here.
29:32You see, it's quite a complex,
29:34but hopefully quite a robust construct.
29:37Yeah.
29:39So the potential complications are,
29:42I go in and the bone is mush,
29:44and I have an awful time.
29:45But I've made every possible plan I can
29:48to try and avoid that
29:49and to try and save the leg.
29:52All right, Cleo, you come with me, sweetheart.
29:54Yeah.
29:55We're going to go and see all the girls.
29:59All right, I'll call you tonight.
30:01Come on, Cleo, we're going to play a game.
30:02See you later, guys.
30:04See you.
30:04Bye.
30:06Just not to lose that leg,
30:07that's what I'm really worried about, I think.
30:10I don't want her to lose that leg.
30:12It's a horrible feeling, really,
30:13because I've been wanting this day so much,
30:17but dreading it at the same time,
30:19because I don't want to leave her.
30:21I just want her to be well,
30:24because she is a really nice dog.
30:26Cleo is taken into theatre.
30:28Noel begins by opening up her leg,
30:33revealing the condition of her hip and current implant.
30:39Oh, man, it's a freaking mess.
30:42So we can see here where there's a big area of bone that is eroded.
30:47You can see the stem sticking out with no bone on it.
30:50To remove the old stem,
30:53Noel needs to slice along the length of the femur
30:55and take a section out of the side like a lid.
31:00But there's a risk it could fracture.
31:02Don't be very careful now.
31:08Don't twist, don't twist.
31:10We'll have a fractured femur in a heartbeat.
31:12Do not twist.
31:15Don't move.
31:16I'm just popping the lid off now.
31:19Okay, we're going to try and bash the stem out now.
31:22We'll see what happens.
31:23We've got to be very careful we don't fracture the femur.
31:26Okay, it looks like it's coming out, so that's good.
31:28There's the stem.
31:35Noel now needs to remove the cement
31:38from the previous two failed hip replacements.
31:42As soon as I take this cement out here,
31:44this is all going to crumble.
31:47So super, super, duper careful.
31:53Be very careful.
31:55We've got a piece breaking off here.
31:57Let go, let go.
31:58So it's very important we get all the cement out
32:01because the cement can act as a focus for infection.
32:07With the old cement successfully removed,
32:10a bespoke plate is attached to the femur
32:12to prevent fracture of the weakened bone.
32:16We're going to put the bone lid back on, like so.
32:20A specially coated half-barrel attached with lasso wires
32:24is used to fill the defect in the femur and encourage bone growth.
32:28You can see the grooves along here hold the wire.
32:32And that wire holds on this half-barrel.
32:36Fresh cement is pumped inside the femur.
32:38And a new stem is inserted.
32:46Noel then focuses on adding a new bespoke hip socket.
32:50This is the cup that we're going to bolt onto the side of the pelvis.
32:53It's got five screw holes in it
32:55that we're going to bolt onto the side of the ileum.
32:57And it's got mesh in the back into which we can get bone to grow.
33:00With the metal cup anchored in place,
33:03Noel cements a plastic liner inside it.
33:06He then attaches a metal ball to the stem.
33:09It's then pushed into the cup,
33:11forming a new hip joint.
33:12So we can see the new cup and head now.
33:15We can see it all moving in place.
33:18And hopefully the pelvic bone will grow onto this cup permanently.
33:30Okay, done.
33:42Cup looks good.
33:48Well, we've done our best.
34:03Oh, you little monkey, do you want a grok?
34:04Can I have a gravy bone?
34:07So handsome.
34:10Hello.
34:11Come on then.
34:12Come on, Michael.
34:14Oh, such a good boy.
34:17It's been five days since Koa had surgery on his deformed leg.
34:23The leg is too short,
34:24so using a technique known as distraction osteogenesis,
34:28Noel will grow the bone an extra seven centimetres while it heals.
34:33There's two factors that come into play when we're making bone grow.
34:38One is rate and one is rhythm.
34:40Rate is the rate at which you turn the dice.
34:44So if you turn it, for example,
34:46one millimetre a day, one and a half millimetres a day,
34:48or two millimetres a day, that's the rate.
34:51The rhythm is the number of times you do it per day.
34:55And all of that is based on experience.
34:58So ideally, I would like to turn a half a millimetre four times a day.
35:08We're now going to start turning the dice.
35:14Two, three, four.
35:20Always remember to turn toward the right with this frame.
35:24You got it?
35:25It will take six more weeks to fully lengthen Koa's leg.
35:37At Noel's Guildford Hospital,
35:3911-year-old Kwanda is recovering from her surgery
35:42to remove a cancerous tumour from behind her eye.
35:45Today, Patricia has been called in
35:57to find out whether or not the cancer has spread
35:59and if she is finally able to take Kwanda home.
36:02She's been here a long time.
36:05I'm actually excited about seeing her.
36:08I need my special girl back, please.
36:10Right, so Kwanda's doing really well.
36:13Good.
36:14We've had the results from pathology.
36:15Yes.
36:16And they're good.
36:17Ah.
36:17The tumour, it's a low-grade one.
36:19Good.
36:20So very unlikely to have spread.
36:22Just going to finish by that.
36:23Her face swole quite a bit after surgery.
36:25Yes.
36:26It's just slowly reducing.
36:27She has a little bit of an upper jaw missing here.
36:31Inside.
36:31Yeah.
36:32But you won't see anything.
36:33Okay.
36:34So I'll go get her now.
36:35Okay?
36:35Yes, please.
36:36All right.
36:37I'll be right back.
36:39Hey, Kwanda.
36:41Hey.
36:41Pretty, pretty, pretty, pretty, pretty.
36:43Oh.
36:44Oh.
36:45I've got a nice harness for you, too.
36:48Oh.
36:49So let's have a look at you, pretty girl.
36:51Oh, it's neat and tidy.
36:53Now you've done a lovely job.
36:55We'll try it.
36:55We'll try it.
36:56Oh, no, she's gorgeous.
36:58And you've still got your eye, and that was my worry.
37:00Thank you very, very much.
37:02You're very welcome.
37:03I'm sorry.
37:05The greatest thing, yes.
37:07I've got her back.
37:08And she looks good.
37:09And she's happy.
37:10She wasn't as bad as I thought she was going to be.
37:12It was like looking at a different dog, the different side of the face.
37:15But it wasn't nearly as swollen, and the eyes were moving beautifully.
37:19And I'm sure she's very pleased to be going home.
37:22Although the cancer is unlikely to spread, Kwanda will be back for check-ups, just to make sure.
37:32Two days ago, Cleo, the rescue dog, had complex revision surgery on her right hip.
37:37Jane's back to find out if she's well enough to go home.
37:41Now, Cleo's mummy.
37:44How are you today?
37:45I'm getting fine.
37:48Cleo's doing fine.
37:50We're going to require quite a lot of rehab, but that's okay.
37:53If we look at the post-op CT, it's very promising.
37:57So that's the half barrel.
37:59That's the plate.
38:00That's all surrounded with cement, which goes down to there.
38:03And the plate, as you can see, takes all the load down to there.
38:06You can see the plate going right down to there.
38:09And again, from the front.
38:11That's amazing, isn't it?
38:12There's a lot of hardware in there, isn't there?
38:15Yeah, it certainly is.
38:16A lot of hardware.
38:18That looks Cleo-proof.
38:20I hope it's Cleo-proof.
38:22So do I.
38:23We're going to bring a mat in, and we're going to do a little physio for you, show you how to do that.
38:27Okay, friends.
38:28Hello, mate.
38:30There we are.
38:30Who's in here, sweetheart?
38:31Hello, gorgeous.
38:35Hello, you're meant to be good.
38:37Now, sweetie pie.
38:39There's some swelling here, which is inevitable.
38:41Yeah, I can see.
38:42You can just massage that way.
38:44Right, so just massage it with your hands like so.
38:47You can see that's already gone down, you see that?
38:49Yeah, okay.
38:50So that's just going back up the leg.
38:52And it's just maybe four times a day.
38:55Before they go, Noel wants Jane to see how well Cleo has taken to her new hip.
39:02So as you can see, she's raring to go.
39:04Yes.
39:05So that's good.
39:06Good girl.
39:06Well done.
39:07Well done.
39:07Good girl.
39:08That's good.
39:09So already she's dramatically better even just in two days.
39:13Okay, so that's it.
39:14We're done.
39:15Let's open up and we'll get her in.
39:16I'm very, very happy with her at the moment.
39:18As long as that keeps going in that trajectory.
39:21All right, very good.
39:22Okay.
39:22Well done.
39:22Lovely, thank you very much.
39:24You're very welcome.
39:25She is a tough dog.
39:27So I know that she'll work it as hard as she can.
39:31All right, all right, all right.
39:32All right, good girl.
39:33Good girl.
39:34I'm just pleased that we've kept the leg and that she's done so well.
39:40Yes, you're a toughie.
39:41You're a good girl.
39:48Today is a big day for Mel and Rob as it's been seven weeks since they last saw Koa.
39:54It feels like forever.
39:56It does.
39:56Will he recognize us?
39:57He's only a pup.
40:00He's in good spirits.
40:01Yeah.
40:02So the bottom line is everything's going according to plan.
40:05So the full length of the extension is evident on this radiograph here.
40:09So that's 7.2 centimetres from there to there.
40:13That's crazy.
40:14And all of that is newborn.
40:16It's grown well, isn't it?
40:17Yeah.
40:17It looks fantastic.
40:20He should be outside the door.
40:22My heart is racing.
40:23Hello, mate.
40:25Now, who's that?
40:27Hello, everybody.
40:28Ah, there you are.
40:32There you are.
40:33Yeah, so let's take him outside so he doesn't chew it.
40:35Let's get him up.
40:36Wow.
40:39How often do we need to walk him?
40:41As often as you like.
40:4320 minutes max.
40:44Really?
40:45Mel and Rob will need to perform physio at home to stretch Koa's tendons, which have not grown at the same rate as the bone.
40:52But this is what I'm talking about.
40:54I'm talking about stretching each toe so the toe must go up.
40:58He doesn't particularly like it because it hurts.
41:01Yeah.
41:01How often do we need to do it?
41:02Ten times and do it three times a day.
41:04Right, okay.
41:05Good, so you're happy?
41:07Yeah.
41:07You know what to do?
41:09Yeah.
41:11It's lovely to get him back.
41:14It is.
41:15He's grown so much.
41:18It's nice to see his nice straight leg, isn't it?
41:20Yeah, and him so happy.
41:24We've got a bit of work to do with the physio.
41:28It looks a bit daunting, to be honest, but it's for his best, so head down, do it.
41:35Koa's leg will continue to grow naturally and heal over the next few weeks.
41:40Only when it's strong enough can the frame finally come off.
41:44In Kent, 11-year-old Kwanda has finally been given the all-clear from cancer.
41:53Kwanda is doing brilliantly.
41:56I thought at one stage we weren't going to get her back.
41:59Now that her face has started to grow, she looks more like her old Kwanda.
42:04She's got rid of all her wrinkles and everything else.
42:07She's definitely using the eye because when you throw her a biscuit or anything,
42:12you can see her balancing and she catches it.
42:15Good girl.
42:17We've both survived cancer and it's so nice to have her back.
42:20Very good that we are a pair again, yes.
42:24To have her here and see her running around with the others
42:27and know that she's fit here again is wonderful.
42:31She's back to her normal self.
42:37In Hampshire, it's been 13 weeks since rescue dog Cleo's third hip replacement.
42:43To say that we've put everything into getting her hip right is just putting it mildly.
42:50She's a lot freer now.
42:53It was worth waiting for.
42:54Everything's gone into it.
42:56My animals are very precious to me.
42:58Very precious.
43:01She's so rewarding.
43:02She's such good fun.
43:03She lives life to the full and it's got to be worthwhile.
43:07Isn't it?
43:08Feeling clear.
43:09You know, they're just part of the family.
43:11It's very important to us that she's able to run and do and she does.
43:15As you can see, she's very, very powerful.
43:18And to see her running and being able to use herself properly is just fantastic.
43:25It's been a very long journey.
43:28I just wanted to be able to live her life now, you know,
43:30and I want her to maximise that and she does.
43:33It's four months since Noel broke, straightened and lengthened Coa's deformed front leg bones.
43:45His leg is now fully grown, so the frame has been replaced with pins and a metal bar.
43:50Today, Noel will check if the bones are strong enough to support themselves.
43:54We're hoping that that metal bar is coming off today and we are very, very excited about it.
44:01We're excited for him.
44:03We have to restrict him severely.
44:04He just wants to get on with life.
44:06So the key thing here today is whether or not the bone is solid enough to take the frame off entirely.
44:21I really hope it is, because no frame is designed to stay on forever.
44:27It's an anxious wait for Mel and Rob, while Noel tests the strength of the bones.
44:33OK, so the moment of truth.
44:35And looks at the final scans.
44:43Good news.
44:44Yay!
44:45I like good news.
44:46You've got no frame.
44:48Oh, that's fantastic.
44:51Thanks, Noel.
44:51That's brilliant.
44:52Finally, no pins coming out of the leg.
44:55Looks good.
44:56Yeah, sorry.
44:58That's right.
44:58Good, good.
44:59We're near the end.
45:00Near the end.
45:00Near the end.
45:01Good job.
45:01Good job.
45:02Long journey.
45:03Especially with him.
45:04Yeah, long journey.
45:04Mr. Bounce.
45:05Yeah.
45:06You've done great.
45:07After four difficult months, it's the result Mel and Rob were hoping for.
45:12Great news.
45:13The bar's off.
45:15His right leg.
45:16Happy days.
45:17It's nice to get good news.
45:19It is.
45:20For a change.
45:21Yeah, it's good.
45:21We can start going for walks of more than 20 minutes.
45:26And excellent for him, because we need to take the energy out of this one.
45:32And four weeks later, Koa is finally back to his best.
45:41It's lovely to have him home.
45:44He's doing what a dog's supposed to be doing.
45:50He's very excited about life.
45:54Little things that are great, off the lead, running the water, on the beach.
45:59You can chase him.
46:00He can chase you.
46:01We are loving life.
46:05Absolutely amazed that Noel has managed to grow Koa's leg by over seven centimeters.
46:12Koa has freedom, running with dogs, playing with other dogs.
46:19Being a dog, it's a dream come true.
46:21All right.
46:24Bye.
46:25Good boy.
46:26Bye.
46:34Bye.
46:39Bye.
46:40Bye.
46:41Bye.
46:41Bye.
46:43Bye.
46:43Bye.
46:44Bye.
46:45Bye.
46:45Bye Bye.
46:46Bye.
46:47Bye.
46:49Bye.
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