A world first prosthetic implant uses groundbreaking biotechnology techniques to put an American bulldog back on his feet
Veterinary breakthrough also brings new hope for injured motorcycle victims
The boundaries of veterinary science have taken another giant step forward in a groundbreaking combination of surgical expertise and bioengineering, which has seen the development of a prosthetic implant that allows tendons to literally ‘grow’ into metal and restore total mobility and function. In March this year, an 8 year old male American bulldog called Roly, underwent successful surgery at Fitzpatrick Referrals – a specialist veterinary clinic in Surrey, following diagnosis that he was suffering from cancer in his rear hind leg. Nine weeks after the procedure, Roly is able to walk again, thanks to the insertion of a unique metal implant that mirrors the original femur and boasts a tendon in-growth attachment, so that effectively tendons and muscles have been fully re-attached to the artificial limb.
The clinical procedure involved a highly complex two-hour operation, during which Dr Noel Fitzpatrick, one of the world’s leading neuro-orthopaedic veterinary surgeons, replaced the cancerous femur bone and hip joint with a specially constructed artificial prosthesis, while re-attaching the musculature and realigning the relative position of the joint to restore perfect movement to the dog.
The prosthesis was designed by collaboration of Professor Gordon Blunn, Head of the Centre for Bio-Medical Engineering at UCL’s Institute of Orthopaedics and Musculoskeletal Science; veterinary surgeon Noel Fitzpatrick and Jay Meswania from specialist implant manufacturer OrthoFitz.* Their three year collaboration is a perfect example of the benefits that can result from developing partnerships between experts in separate but related clinical disciplines.
As Professor Blunn explains: “What is significant about the design is the way in which it sandwiches tissue and metal together overlaying the gluteal muscles onto the top of the endoprosthetic femur – alternating tendon, synthetic Dacron mesh, tendon, synthetic Dacron mesh, tendon and finally trabecular metal – which has a honeycomb surface resembling a series of small chambers. In this way, the hope is that the Sharpeys fibres which attach tendons of muscles to the bone will grow into the trabecular metal surface and permanently adhere to it.”
“This truly remarkable achievement was made possible through the convergence of biomechanics, biology and surgical innovation,” explains Noel Fitzpatrick. “We tapped into the evidence provided by the CT and MRI scanners we have in place at the practice, so that the data collected about Roly during clinical diagnosis was used to design and construct an artificial femur which exactly mirrored his original limb. It has been constructed rather like a telescope – one section fitting inside the adjoining section, so that we get maximum flexibility and traction during motion.”
Roly is a rescue dog owned by retired aeronautical engineer Dennis Hoy and his wife Sue from Farnborough in Hampshire. The first sign they noticed that something was wrong with Roly was when he started lifting his left hind leg in the air, yelping and walking on his other three legs, which led their vet Ian Kynoch in Farnborough to refer him to Fitzpatrick Referrals for a specialist diagnosis. MRI and CT scans performed at Fitzpatrick Referrals showed that a malignant bone tumour, osteosarcoma, was the cause of the problem.
Dennis Hoy takes up the story: “When Noel explained the options, it was clear to both of us what we wanted to do – euthanasia was not a consideration as Roly is a young dog and very much a part of our family. Nor was amputation realistic in our opinion, given the fact that he weighs around 50 kilos and has arthritis and ligament problems in lots of joints – so limb salvage seemed the only practical and compassionate solution. I was confident that Noel and his team knew exactly what was clinically possible and most of all in Roly’s best interests. The results of the treatment have confirmed my trust. After the operation, Roly had four chemotherapy sessions and will have to have one treatment every three months for the rest of his life…. saying that my vet has been amazed at the result and I cannot wait to get back to the hour-long walks we take three times a day together!”
Fitzpatrick Referrals is a leading veterinary referral practice in Surrey which specialises in small animal orthopaedics and neuro-surgery. The £10 million centre which was completed in March 2008, boasts three specially equipped operating theatres, CT and MRI scanners and a specialist rehabilitation centre with physiotherapy and hydrotherapy facilities.
Through his pioneering work Noel Fitzpatrick and his 65 strong team aim to push back the boundaries of conventional veterinary practice. This involves innovative surgical procedures, particularly in cases of aggressive cancer or irreparable trauma, as well as bioengineering to develop state-of-the-art internal and external prosthetic limbs.
Other advancements which are unique to Fitzpatrick Referrals include stem cell and cartilage transplant technologies; spinal disc replacement and fusion techniques; bio-absorbable implant systems; joint replacements and external skeletal frames for correction of congenital or traumatic bone disorders and for bone regeneration.
As Noel Fitzpatrick concludes: “Hip replacement is common here. We do more than 50 a year, on animals as small as a cat or a Chihuahua. But this hip replacement was special, and to my knowledge, the first of its kind in the world. It’s important though to emphasise that this technology must only be employed when it is in the best interests of the individual patient. It’s not enough to be able to do something; it must be done for the right reason in every case without exception. It must be ethically right. It’s also important to emphasise that Roly will probably not live for a normal lifetime because bone cancer generally spreads to the lungs over time in spite of chemotherapy. However, this technology is equally applicable for dogs and cats affected by trauma who will likely live longer. My job is to look after my patients as best I can and to be honest with their guardians and give them options. What I do is provide pain free functional quality of life for as long as my patient is alive. That’s important and that’s special, but the decision must remain with each and every individual animal owner”.
While Roly’s experience has been a triumph for the dog and his owners, it undoubtedly has potentially life-changing implications for both animals and humans. This breakthrough is especially important for human accident victims, such as motorcycle accidents where a key challenge to recovery may be successfully re-attaching the kneecap tendon onto the top of the tibia in the lower leg. Another example would be repairing ruptured tendons in the shoulders of human tennis or cricket players. It has long been part of Noel Fitzpatrick’s underlying philosophy that veterinary and human medicine are closely interdependent and advances in either field have profound implications for the other. Hopefully one day, all vets and all doctors will appreciate this. One life – one medicine – that’s what it’s all about!
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Notes to editors
- Fitzpatrick Referrals, a leading veterinary referral practice in Surrey which specialises in small animal orthopaedics and neuro-surgery
- The £10 million centre which was completed in March 2008, boasts three specially equipped operating theatres, CT and MRI scanners and a specialist rehabilitation centre with physiotherapy and hydrotherapy facilities.
- The practice was officially opened by HRH The Duke of Kent KG in November 2009
- Orthofitz is an implant design business set up by Noel Fitzpatrick to design, develop and manufacture customised and prosthetic implants for his patients.
- The Fitzpatrick Referrals team includes three veterinary surgeons, two surgical residents, five international interns, post-graduate researchers and undergraduate student placements, veterinary nurses, kennel staff, physiotherapists, hydrotherapists and a radiographer, plus front-of-house and administrative support .
- A distinguished academic and speaker, Noel Fitzpatrick has authored innumerable scientific abstracts and lectures widely in the UK, USA and Europe.
- In 2009 he was awarded the prestigious Simon Award from the British Small Animal Veterinary Association in recognition of his outstanding contribution to veterinary surgery.
- Fitzpatrick’s approach is embodied in his One Life One Medicine philosophy, which envisages human and veterinary medicine as becoming more closely aligned, combining compassion with clinical excellence.
- For further information visit, www.fitzpatrickreferrals.co.uk
