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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 skipping
10:15Give me all the skipping
10:19Why are they so pretty?
10:23I've got off the sheathen
10:24Why are they so pretty?
10:25Why are they so pretty?
10:26Why are they so pretty?
10:35Bertie, the seven-month-old fox red Labrador puppy,
10:38has had CT scans to assess what can be done
10:41to alleviate his painful ankle.
10:45I love red Labradors.
10:47I'm going to say that I'm fox red now.
10:49I'm not Ginger, I'm fox red.
10:51This is beautiful.
11:00These are the CT scans right here.
11:02There's a massive hole on the left side.
11:05It's a critical size defect.
11:08The other side, unfortunately, is affected,
11:12but to a lesser extent.
11:14If we look at the lesion, it's the same but smaller.
11:19So you're here in time, but only just.
11:23Cool everything?
11:25Yeah.
11:26I absolutely do not think the fragment removal
11:28is going to be of any use whatsoever.
11:30So we either go down the route of tablets
11:33until you get a bit older and fuse it,
11:35but with two ankles fused,
11:37you'll have a stilted dog forever.
11:39Or crack on as soon as we can
11:42and put a resurfacing in there.
11:44At such an early age,
11:48the bouncy pup is facing not one,
11:50but two ankle operations.
11:53By all means think about it,
11:54deliver that for you.
11:55I don't think we need to think about it.
11:56Right.
11:57So I'll ask the engineers to look at the CTs tonight
11:59and I'll come back to you with an answer tomorrow
12:01on time frame.
12:02Okay, brilliant.
12:03Yeah.
12:06Good boy.
12:07Both of his legs are affected.
12:08The left's a lot worse,
12:09so basically you're going to have
12:11a sort of partial joint replacement in each.
12:14Because without it,
12:15he'll not only be in pain,
12:16he'll get arthritis quite quickly anyway.
12:19It's just upsetting
12:21because you can't explain to him what's happening.
12:23Whereas with a patient,
12:24you can do that.
12:25And I find that quite difficult emotionally.
12:27It's early evening.
12:42Jade, the rescue cat,
12:44is being prepared for her total knee replacement.
12:47Her implant has been 3D printed based on her CT scans,
12:52but operating on Jade won't be routine
12:55due to her deformed leg.
12:57So in real life,
12:59the kneecap should be somewhere up here
13:02on the front of the knee,
13:03but instead it's over here on the side of the knee.
13:08Noel's first challenge is to cut out the deformed joint
13:11and prepare the fragile bone for the implants.
13:18So I've made sure that I can flex the ankle
13:20and line up the front of this implant
13:23so it's exactly perpendicular to the tibia
13:26and exactly parallel to the ankle.
13:29If the implant isn't straight,
13:31then Jade's kneecap could continue to dislocate.
13:36Okay, I think that looks pretty good.
13:37Now we'll prepare the femur.
13:43You can see here where we've shaped the stem
13:45in a curve to fit the very curved femur
13:47when we push it in.
13:50So this is very difficult to sculpt
13:52because the femur is bent
13:54both on the outside and the inside.
13:56So the marrow cavity is also bent.
14:01Finally, Noel needs to relocate the kneecap into the groove
14:08and connect the tiny femur and tibia implants
14:11with a specially hinged plastic bushing.
14:14You can see here that the knee can flex, extend, and also rotate.
14:24So physiotherapy is going to be critical to success.
14:28We've no idea yet how Jade is going to use this knee.
14:31The function will be entirely dependent
14:33on whether the quadriceps muscle can loosen up enough to flex.
14:39We can only do our best.
14:41Okay.
14:42This morning's patient is also looking to Noel to fix a painful knee.
14:48Joe's brought in her four-year-old springer spaniel, Sophie.
14:52Hello.
14:53Just take a seat.
14:54They're not going to be long.
14:55Thank you very much.
14:56We are here because when she was a pup, she had luxating patellas.
14:58So basically it's the kneecap slipping in and out of the joint.
15:00It's not staying in.
15:01We are here because when she was the pup she had luxating patellas.
15:05So basically it's the kneecap slipping in and out of the joint.
15:06It's not staying in.
15:07they're not gonna be long thank you very much we're here because when she was a
15:14pup she had luxating patellas so basically it's the kneecap slipping in
15:19and out of the joint it's not staying in Joe lives 400 miles away in Cheshire I
15:29live on my own with my three dogs and hope Sophie and Indy Indy is currently
15:36nicknamed Dobby because she keeps stealing sops oh I love the springer spaniel breed
15:50due to Sophie's condition she's not been able to join in the games they are a lovely family unit
15:58and they include me in that as well which is nice I know some people don't seem to understand that
16:06bond between people and and dogs sometimes but for me it's a very profound bond and I do have to
16:17remind myself that they are dogs not children the others are still doing that sort of running around
16:24and just clearly loving life that's why it's so sad with Sophie a little bit is because she's so tied
16:30down Sophie's had three surgeries already so far and time away from me has made her even more clingy but
16:40certainly if we ever go back to the vets she'll sit on my knee and cuddle in just wanting reassurance
16:46Sophie's operations were for a slipping kneecap and a cruciate ligament rupture on the same knee but both
16:55failed to hold the kneecap in place and she's also had surgery on her right elbow I can't see what
17:03else they can do um sorry I see it as her last chance to get it right I feel like I've tried to do my
17:17utmost with the physio and the hydro and doing it at home and it just hasn't worked so I think it's
17:25just wanting a final surgical solution so it is 13 months and I just want her to be okay
17:30Jo's local vet has sent noel Sophie's medical history with x-ray pictures of her disease joints
17:41you okay please take a seat you on your own yes I am you're a doctor oh what kind of a psychology I
17:50definitely need you yeah right you're hired that's good okay so which leg is she got a luxating Patel
18:00um both but it's the right one that's had the operations on it when I extend it easy comes out
18:08and then it's completely out and when I put it back in it's in yes yes tough situation isn't it
18:17despite her multiple surgeries Sophie's kneecap is still dislocating the elbows concern me as well
18:26because they're pretty significantly affected by osteoarthritis can you tell that yeah on the right
18:34side especially but also on the left side in terms of the left knee we wouldn't do anything at the
18:42moment it's static with regard to the right knee this kneecap was slipping that way and that way what
18:49you want to do is you want to try and stop the kneecap coming out sideways you've exhausted all
18:54reasonable possibilities of deepening the groove and you've exhausted all reasonable possibilities
18:59of moving the front of the kneecap attachment over if the alignment was okay then there will
19:07be ways to address it one will be to put on artificial ridges to stop it slipping out and the other
19:15question is whether we perform arthroscopy on the elbows at the same time or not okay for me you are her
19:22last hope in relation to her back leg at least I wasn't expecting the front legs today but you
19:29know I'd be grateful for them to be done I certainly think we should check it I hate the thought that she
19:36she is in pain
19:45leaving her behind was hard but she needs surgery and that's that okay there you go I just wanted to be a
19:54batter I suppose at the end of the day after taking radiographs and CT scans Noel uses an arthroscopic camera to look
20:03inside Sophie's joints he will try and save Sophie's right hind knee joint it's just the ridges on either
20:14side are not high enough to keep the kneecap in now that's the problem instead of removing the whole joint
20:23Noel will design an implant that will aim to keep the kneecap in place next he moves on to Sophie's front legs
20:33you can see that there's raw bone here with no cartilage on it that's not good so that's rubbing
20:43Noel will have to operate so what I'm gonna do is I'm gonna cut the ulna the top part kicks down and
20:50back and then it heals itself without any stabilization so no pin no plate required
20:56luckily Noel won't have to operate on Sophie's other front leg for now there we go the ulna is free to move
21:06it's obviously not going to cure the arthritis but it should certainly help to decrease pain in the elbow
21:15as a result of rubbing it will take about eight to twelve weeks for this to heal properly during that
21:22time we'll be making the new ridges for the knee so the timing is just about right Sophie can go home
21:32in a couple of days to recover but she'll have to wait for a custom implant to be made to repair her
21:38slipping kneecap Sue has brought in seven-month-old Labrador puppy Bertie
22:01her son Johnny has come to help although he too has struggled to restrain Bertie I think the
22:12frustration got hold of Bertie this morning and I picked him up to stroke him and he's gouged my
22:16nose out here and the last four months or so we've had him on the lead a lot and he's just had a lot of
22:22pent-up energy Bertie's gonna have his first of two operations he's having resurfacing of his ankle joint on his
22:31left leg very nervous
22:33Bertie Taylor please
22:35hi guys how are you today hello mate how are you I heard the dog scratch you I'm sorry about that
22:47oh dear yeah he's very boisterous isn't he he's very boisterous here's some tissue there you go
22:55um right okay so you know what I'm doing today I'm going to put a custom ridge onto his ankle joints
23:01or we'll uh we'll give him some sedatives to help him to cope yeah I think that's our main worry is
23:07we're not quite sure how he's yeah it's everybody's main worry because he's so boisterous as you can see
23:12I'm sorry about that okay guys god bless see you later bye bye bye hopefully when he's had the
23:25surgery then he'll get back to being a lovely puppy that can actually get rid of his energy and then
23:31he won't be quite so bad first Noel will access the joint by temporarily removing a piece of tibia
23:45bone next he opens the ankle and prepares the diseased surface to place in the new custom implant
23:51finally he'll fix the ligament attached to the piece of tibia back into position securing it with
23:58special eyelet pins and wire
24:07as we open up the ankle so we can see here where the big hole is and unfortunately that big hole of raw
24:16bone has already rubbed away a bit on the other side here we're just going to sculpt the correct
24:22shape in order to put our implant in so we want this to fit just right okay so that's the metal ridge in
24:36place now we fill the hole what we're going to do now is going to pop it back up into the joint like so
24:42the hope is we can give a functional healthy pain-free joint for a long time then we'll do the other side in six weeks
24:51jade the rescue cat has been recovering at the practice for nine days after her total knee replacement but she's still got a long way to go
25:00she'll need intensive physiotherapy and laser treatment daily to stretch her contracted muscles
25:12joe has returned with her daughter jenny for a visit jade's adores my daughter and she's missed her like crazy she loves her cuddles with you as well doesn't she
25:24yeah i've missed her a lot hello friends there we go come on buba so as you can see there is an effort to use the leg now but it's still to straight okay so what we're encouraging every day is this
25:48now, but it's still too straight, OK?
25:52So what we're encouraging every day is this, like 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.
26:08I'm still concerned whether we're going to get function
26:11or not into that quadriceps, because it's
26:13been deformed for so long.
26:17She's been with us 18 months, and it's just
26:20been slowly getting worse.
26:22Yeah, well, you're not going to reverse 18 months in two weeks?
26:24No, of course we're not.
26:25No, I appreciate that.
26:26And I said to you from day one, it will take as long as it takes.
26:30OK, bub, in you go.
26:32Well done, good.
26:36It's definitely hard leaving her behind,
26:37but we know we're on the road to getting her better and fixed
26:41and hopefully using that leg again properly.
26:45So we're going to be waiting now with bated breath for updates.
26:51See you later, ladies.
26:52We'll see you again.
27:08Lively Labrador pup Bertie has been at the practice for a week after having his first
27:13partial ankle replacement.
27:14take your seat i'll let him know you're here sue has returned to pick him up with her other son
27:22james to give her a hand very excited here i'm a bit worried he's going to go mad
27:29hopefully he won't scratch us like he scratched johnny
27:35this is your new ankle ridge replacement as you can see the objective of the operation
27:40is to replace the entire defect with this cap the cap is a super smooth surface that will rub forever
27:48on the opposing surface of the tibia super clear yeah good post-operative confinement is the main
27:56thing so no running not jumping not slipping not sliding if the family managed to keep bertie calm
28:03hi bertie and everything goes to plan he will have his right ankle surgery
28:09in six weeks time come on mate now here we are it's up to us now really we've just got to make
28:16sure that he doesn't leap around or jump what have you so that he's got the best chance of it
28:22if it working really so just got to do our best
28:27the day has come for joe to leave springer spaniel sophie at fitzpatrick's once again
28:48this time for surgery on her knee you are pups you're gonna have to stay here i know i know
29:02okay it's okay hopefully this operation will be sophie's last
29:07when i left her with she was just looking it was just don't believe me mum
29:16she's my child and i love her that's partly what's crucifying is um
29:23um yeah just just she can't play or anything like that
29:32she is the dog that's with me all the time so it's like i've lost my shadow
29:37first noel starts by preparing the joint for the new custom implant we've drilled away the cartilage
29:49from the old worn groove and now we're going to put a new smooth groove on noel uses bone graft
29:55collected from sophie's bone to create a bed for the new groove to sit on this implant is made out of cobalt chromium
30:03which is three-dimensionally printed from the ct scan
30:10the undersurface is made out of a mesh we've coated it in a mineral called hydroxyapatite which attracts bone cells onto it
30:25okay so we're just going to put the kneecap back into the groove now there we go stitch up we're done
30:38so the kneecap is gliding nicely at the moment let's hope it stays that way
30:41the practice has a specialized rehabilitation center including hydrotherapy pool for many it's
31:00the gateway to a full recovery good boy usually it's the dogs getting the benefit
31:08but surprisingly cats can enjoy it too
31:15some of the time jade is having hydrotherapy a beneficial treatment to help stretch her quadriceps
31:23muscle after her knee replacement
31:30you avoided that one well
31:32after two weeks of daily rehabilitation she's progressing enough to go home
31:45in just a week the improvement there is massive
31:48a little bit apprehensive about the rehab but we'll just keep going and play it day by day at the moment
31:55my daughter's really really happy to have her home she's her little baby so yeah she's she's over the moon
32:08down in hampshire
32:13bertie the labrador pup is at home recovering after having his second ankle surgery
32:18he's on strict cage rest i hadn't realized how hard it was going to be to have him in the crate
32:28you can't leave the room he starts to cry or get upset it's just a sad look that uh is the worst thing
32:40every time you do take him out you're terrified that he's going to damage it it's very intense to be honest
32:45it's not what the puppy should be doing with you know he should be having fun and being able to play and
32:59patty shh he's um you know he's missed out on being a puppy
33:15it's three days after sophie the springer spaniel had what joe hopes is her final knee surgery
33:31she's arrived eager to collect her companion i'll probably describe myself as nervously excited for
33:37some reason i don't know why i just haven't been able to get her off my mind
33:42this is what your implant looks like right so you can see that the surface architecture of this
33:49implant has been designed to perfectly contour the original femur but i'm very pleased with that
33:55and so is your dog so if you push your chair back i will show you
33:58okay come on there there we go good now hello mommy hello mom doing fine oh baby doing fine she's
34:11actually walking on it without too much trouble the kneecaps in a very nice position it's central
34:16everything's good she's wagging her tail she's happy okay thank you all right my entire pleasure
34:21it's great you mean you love her very much and she's very lucky you're very lucky to have each other
34:25like with the harness don't let her jump no and then we'll just support her like that
34:32oh i've missed you this time no no messing with sophie in the car okay be good with her
34:38she's still a bit fragile well safe journey thank you very much no worries take care bye-bye
34:43well you're back home now darling yes it's gonna be fine
35:02orthopedic ankle surgeon graham and his wife sue are back with labrador bertie six weeks after his
35:09second partial ankle replacement well he's still holding that leg up a bit oh i don't know if it's
35:15hurting him or not not as good as the other one graham was concerned there could be a problem with this
35:21second surgery when he's out walking it's good yeah but when he pauses he will sometimes lift it not
35:29always yeah so i'm sort of worried to death yeah yeah all right let's just take him through that's
35:35fine okay let's just go through that okay let's go straight through yeah all right thanks
35:43bertie is immediately sedated and taken for a ct scan
35:49while graham and sue wait
35:51when noel operated on bertie's second ankle he added a metal plate on the side to stabilize the repair
36:02the results are in sadly your hunch was right there is something wrong
36:10it's very unusual i've not seen it before what he's done is he's actually cracked the implant
36:15the metal the metal the metal the other side when we rotate it you can see that there's a nice smooth
36:26ridge and it's actually integrating well there's no issue
36:33but on the other side which is the side that's affected by the swelling but he has cracked the metal
36:40here around the peg before the bone has grown in so i think what's happened is for whatever reason
36:50in the cage or otherwise he's pivoted on it because direct compression shouldn't crack it because it's
36:56got a bomb bed to sit on yeah and it's a tight joint we have some of these out three years now
37:03and they're still fine but i've not seen one crack yet
37:06because clearly he's putting more load on this than any dog we've had before well you've seen what
37:12he's like yeah
37:19i can't leave that the way it is so i've got to replace that and i'll probably have to take off a
37:24couple more mill of bone and make a thicker shell and i obviously feel awful about it but no no it's not
37:31it's not what it is don't do yeah as well you'll understand as a surgeon you're going to get
37:37complications but i definitely did not see that one coming
37:43okay give me a couple of sex i'm sorry okay
37:49you're right to be doom and gloom aren't you it's better than the infection soon
37:54no i don't know i mean he's potentially so horrible
38:01poor little thing i just feel sorry for him oh well that's that's why we feel awful
38:04not only out of the breeze is it i mean you just feel dreadfully sorry for him
38:07no you crazy boy i'm sorry mate stay brave okay thanks ma'am bye
38:25it's a major setback for graham and sue bertie will need yet another surgery to replace the broken
38:32implant but must wait for a stronger thicker implant to be made look at his little face
38:39something had to be wrong it's just going through all again for him he can't play he can't do anything
38:46you couldn't listen to that for long could you
39:02it's a big day in more ways than one is it his birthday today
39:22oh what a shitty way to spend your birthday what a great way to spend your birthday
39:32oh my god yes oh i love it bertie is one year old today
39:44okay so this implant is thicker it's got a thicker surface in here in the middle around the peg
39:50so it's less likely to crack
39:54so that's our new implant in place now looks like a nice fit i'm happy with that it's seating down
40:01nicely okay 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
40:17behavior
40:29joe is back with springer spaniel sophie
40:33she's hoping that sophie's latest surgery has finally stopped her kneecap slipping
40:38all right sophie good girl let's have a little bit you good girl well done so you've been following
40:45the rules i can see i've been doing my best right has she escaped at any time
40:51um she's got on and off the safer well at least you're being honest
40:55so i'm gonna take an x-ray picture to make sure that the illness healing as well as
41:03an x-ray picture of the right knee today is an important day because today is all about
41:09is the kneecap tracking appropriately and is the implant intact yeah one of the things i've forgotten
41:15actually she's actually in season all right um and my other dog is quite gay with her oh i see and
41:24i turned around when she came in disease and she was twice she'd got onto a bat i was like no
41:29humping and jumping
41:32i couldn't believe it was something okay that wasn't on the post-operative uh confinement sheet
41:38it should say no humping and no jumping the x-ray pictures have been sent through the good news is
41:49that the line of the kneecap is very nice now and it's in its groove and it's seated very nicely
41:55and the elbow now you can see bonnie healing there so that's all hunky-dory
42:02no need to cry at least at least they're tears of joy
42:06i know it just feels like it's been a long long journey now you still have a little bit of the
42:10journey to go because you've lost a shed load of muscle you know yes yeah that seemed to go overnight
42:15yes yeah that needs to be really worked on
42:22now there we go thank you very welcome well done thank you now no off lead and no humping and no jumping
42:29no no no no no humping no jumping okay thank you all right take care thank you
42:36no hunting no jumping
42:47at home in cheshire joe and sophie are taking their homework very seriously
42:54i get up at half past four i do the muscle stimulation with her before we go out for a walk
43:01probably 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
43:11walking over the poles good girl sit to stands good girl i'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
43:25is that all we do so
43:32and the hard work has paid off so i started letting her off the lead just a little bit in this garden
43:37but it's not very much at all i do get a little bit worried if she picks up speed and she starts
43:42running around in circles and things and hopping as she goes so i'm trying mostly just to keep her
43:47exercise nice and steady i have managed to avoid sophie being humped especially because my other two
43:54dogs are in season my oldest one tried and then i managed to stop her in time so that's okay
44:01i'm very very grateful to noel for what he's done she's got a lot of years ahead of her still
44:06at home in surrey after a grueling four months of physiotherapy to stretch her leg muscle jade is
44:19finally making steps in the right direction the op obviously was the major part getting
44:25the knee fixed but without the physio we wouldn't have the cat we've got today jade does live in a
44:32house with eight other cats some she doesn't get on with quite so much but you know being able to
44:39move around more freely now and be able to run she can choose who she interacts with and who she doesn't
44:48she tends to stick with upstairs and she has her own little space
44:52hey good girl yeah come on get it
44:56she's playing really well she loves to jump around run around now
45:04she never used to do any of this so it's just amazing to watch her
45:14hey good boy look at you in hampshire after three surgeries and nine months of treatment
45:21bertie the energetic labrador is finally catching up on his missed puppyhood he's doing really really
45:28well we're really pleased and he's really able to play with ollie and just have a great time it's
45:35left its mark we both put on half a stone comfort eating you know you get you get quite depressed
45:40looking at your dog behind bars but it's all been worth it i think he's comfortable he's cheerful
45:46he's jumping on the furniture again if you don't really keep an eye on it
45:49i'm pleased that we went for the partial resurfacing rather than having a fusion we felt it was unfair
45:58in a young dog to to do that really i'd like it very much if we had an implant that we could use
46:04in humans which is similar to the one that bertie's had technology's there it could be done clearly it's
46:08been done in bertie so there are a few patients who benefit from that it's just lovely seeing him you
46:16you know just bounding around the garden and exploring it's just lovely to see
46:29you
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