Hip & Knee Replacement for Patients from East Hawai‘i

Outside Hilo town, East Hawai‘i has no Pacific Bone & Joint clinic, so people along the Hāmākua Coast and in Ka‘ū drive to a clinic for visits and to Hilo for surgery. What draws them is a surgeon from this side of the island. Dr. Morton grew up in Kea‘au, studied medicine at the University of Hawai‘i with half of his third-year rotations on Hawai‘i Island, and came back after fellowships in hip and knee reconstruction (University of Chicago) and AO Trauma (Charité, Berlin). Roughly half of his work is revision surgery that other surgeons send him, which matters if your question concerns a replacement you already have.

Just as important is what patients no longer need to do. For most routine hip and knee replacements the trip ends in Hilo, with no flight. O‘ahu enters the picture for complex cases, as the travel guide’s Hawai‘i Island section explains.

Most first-time replacements can be done in Hilo with Mako, each one mapped out in 3D beforehand from a CT of the joint. That covers total hips by the direct anterior route, which opens the capsule and leaves the muscles on bone, total knees, nearly always through the subvastus route that spares the quadriceps tendon, and partial knee replacement when arthritis is limited to one part of the knee and the ACL is intact. Partial knees come in medial, lateral, patellofemoral and bicompartmental forms; Dr. Morton performs each type, and your exam shows which, if any, fits.

Revision is where the map widens. Where a loose or worn implant has left bone loss, the rebuild may call for porous augments, cones, sleeves or revision stems, and hip and knee revisions are planned at a hospital, typically on O‘ahu. The workup decides which kind of case yours is. The reasoning behind each choice is on the philosophy page.

Yes. Requesting and going through your records is part of what the office does before you come in, and scans taken at Hawai‘i imaging centers usually reach the office electronically. If you have copies, you are welcome to upload your images (opens in a new tab) ahead of time so they are waiting at your appointment. Sending them that way does not count as a review and does not set up a visit.

For a joint that was already replaced, gather your operative report and the implant card or stickers. Knowing the model, size and recall status early helps the workup and, if a revision is needed, the hospital planning. Dr. Morton goes through the imaging personally at your visit. If living in Honoka‘a or Nā‘ālehu makes an in-person first visit impractical, a video visit while you are in Hawai‘i can come first, with new X-rays ordered on the island near you.

A good share of it can happen near home. Talk to your primary care provider early about medical clearance; the surgical and anesthesia teams then weigh your heart and lung health, your medication list and how you have done with anesthesia before. Any pre-operative tests your health calls for, such as a blood draw or an EKG, are spelled out by the office, which can book them; ask if they can happen closer to Honoka‘a or Pāhala.

Use the time to get stronger and safer for surgery. Stopping tobacco well beforehand helps healing; the Hawai‘i Tobacco Quitline is 1-800-QUIT-NOW. There is no universal BMI cutoff, and each patient is evaluated individually. Get a dental checkup now, because elective dental work waits about three months after surgery. The team will tell you which blood thinners or supplements to stop, and when. With managed-care, HMO or Medicaid/Quest coverage, a PCP referral may be required, and the office checks that for you. The optimization notes go further.

From the Hāmākua Coast or Ka‘ū, plan on a small number of Hilo days and make each one do more than one job. The stops that need you in person are the exam, the planning CT, the operation itself, and a first post-operative visit roughly a week later. Questions in between, and many later check-ins, can be handled by video on your phone. Ka‘ū patients who see Dr. Morton at the Kona clinic keep their office visits in Kona and come to Hilo for the operation itself.

When a case belongs on O‘ahu, the O‘ahu portion is usually a single trip that brings together the hands-on exam, the final round of testing, surgery and the start of recovery; your consultation and later check-ups remain on Hawai‘i Island. Complex cases occasionally need an extra visit, and that is settled before you book anything.

When an East Hawai‘i patient needs a routine hip, knee or partial knee replacement, it is usually performed at Hilo Community Surgery Center. It is a same-day facility where nobody stays the night; discharge comes when you can walk safely with your walker, tolerate food and drink, and keep pain in check with oral medicine. Dr. Morton leads the surgical decisions and performs every operation himself, using Mako to keep the work true to the CT-based plan, while nurses, anesthesia providers, his physician assistant and physical therapists look after other parts of your care.

A hospital is chosen from the start when your health may call for a night of monitoring, or when the work involves a complex revision, an infected replacement, or significant bone loss. For Hawai‘i Island patients, that usually means The Queen’s Medical Center in Honolulu, which holds The Joint Commission’s Advanced Certification for total hip and total knee replacement. The setting follows your operation, your health and your coverage, and you will hear why.

For surgery in Hilo, “nearby” usually means home. You are discharged the same day; if the ride back to Ka‘ū or the far end of the Hāmākua Coast feels long, ask the team about a first night near Hilo. A companion stays day and night for at least 24 to 72 hours. About a week after surgery you return for the first post-operative visit, in Hilo or, if that is where you are seen, Kona.

If your surgery is on O‘ahu, budget about 10–14 days there before the flight home: enough time to get through your first check after surgery and receive fit-to-fly clearance. It is a range to plan around rather than a promise. Many patients pick a hotel or condo along the Ala Moana–Waikīkī corridor. Check that the property is ADA compliant, has an elevator, and has space for whoever comes with you; the care coordinator shares recovery-friendly suggestions once surgery is scheduled. The office can also tell you whether your health plan helps with interisland airfare or lodging for off-island care. See interisland travel for the full picture.

No one expects you to drive to Hilo for therapy. Choose any licensed physical therapist convenient to where you live, whether that is a clinic you can reach from the Hāmākua Coast or Ka‘ū or one who makes home visits. The office can suggest therapists near you and sends Dr. Morton’s phase-by-phase protocols straight to them, so you are not left explaining the plan yourself.

Sessions usually begin a day or two after you get home. If your operation was on O‘ahu, it begins there and continues with a therapist on Hawai‘i Island once you are back. Video visits let the team review your progress and adjust therapy, which spares a long drive for a routine check. Most people walk with a walker for about the first couple of weeks before moving to a cane, so arrange rides to therapy until Dr. Morton confirms you can drive.

For East Hawai‘i patients, an O‘ahu operation is most often a revision or a case that needs hospital monitoring, and the flight home is timed to your recovery. You fly once the surgical team clears you, never on the day of surgery. Ask the airline for wheelchair or cart help when you book, and check how your walker will be arranged; the hospital or your insurance often provides one. In the air, sit on the aisle, get up to walk when you can, stay hydrated and keep your ankles moving. Follow your prescribed clot prevention exactly; flying is not a reason to take extra aspirin.

At security, most implants set off the walk-through detector; say which joint was replaced, and no card is needed. Back home, you have written instructions on what to watch for, and the team stays in touch with your physicians on the island. Read after you return before you go.