Hip & Knee Replacement for Patients from Puna, Hawai‘i

Puna has no Pacific Bone & Joint office, which means most in-person steps involve heading into Hilo on Highway 130 or Highway 11. Patients from Pāhoa to Volcano make that drive for two reasons. One is that the operation itself can stay on Hawai‘i Island: for most patients, a robotic hip or knee replacement is done at Hilo Community Surgery Center rather than on O‘ahu. The other is the surgeon. Dr. Morton is a Fellow of the American Academy of Orthopaedic Surgeons and of the American Association of Hip and Knee Surgeons, did his hip and knee fellowship at the University of Chicago, and grew up in Kea‘au, inside the Puna District.

The aim here is to make each drive count. Some steps can happen near home or on your phone; the trips that remain are the ones where an exam, a scan or the operation needs you in the room. The travel guide’s Hawai‘i Island notes fill in the rest.

Which operation fits depends on your joint, not your address. Mako, the robotic system used in Hilo, builds each hip and knee plan from a CT of the joint being replaced. Dr. Morton performs every step; the arm keeps the bone preparation within his plan and makes no decisions. For a knee, the first question is whether arthritis is confined to one compartment with a sound ACL, in which case a partial knee may work. Nearly all total knees are done through the quad-sparing subvastus approach, and no first-time knee uses a tourniquet.

For hips, the direct anterior approach is his standard. Muscles stay attached to bone and only the capsule is opened, which is why most people skip the usual hip precautions; where your anatomy allows, the incision can follow the bikini line. Fixing an earlier replacement is a separate conversation, and revisions are planned at a hospital; the philosophy page shows how these choices are made.

Yes, and that is the first drive you can save. Studies from Hilo-area imaging facilities, like most done in Hawai‘i, can usually be sent to the office electronically and be waiting when you arrive. If you hold copies yourself, upload your images (opens in a new tab) through the practice’s portal. Uploading keeps them on file for your visit, but nobody reviews them from the upload alone, and no appointment is created.

The reading itself happens at an appointment, where Dr. Morton looks at the films personally. When getting to Hilo is not practical, that appointment can be a video visit on your iPhone or Android phone, provided you are in Hawai‘i during the call. He can take your history, watch how you move, and go through the images with you. If your imaging is old or missing, the office can order new X-rays at a Hilo-area facility first. An in-person exam still comes before any surgery.

More than people expect. Your primary care provider usually handles medical clearance, so that step can stay close to home. Your health decides the pre-operative tests, which may include blood work and an EKG; the office lists exactly what is needed and can set it up, and you can ask to have it done near home rather than in Hilo. The anesthesia team and Dr. Morton then go over your heart, lungs, medications and past anesthesia.

One step does need a scanner: the CT that your Mako plan is built from, taken without IV contrast. The rest is preparation you control. Get a dental checkup, work with your doctor on blood sugar if you have diabetes, stop smoking, and start the prehab exercises early. Follow the team’s instructions on blood thinners and supplements. At home, plan for any steps or stairs up to the door before you have to climb them with a walker.

Hilo is for the moments that need you in the room: an in-person exam before surgery, the CT scan at a Hilo-area facility, surgery day, and the first check-up about a week after the operation. Much of what surrounds those can be lighter. A consultation or a check-in between clinic days can happen by video, and X-rays can be taken on a day you are already in town. When you schedule, ask whether two steps can share the same day.

Some Puna patients are planned for surgery on O‘ahu instead, usually for a complex revision or a health issue that calls for a hospital. That generally still means one O‘ahu trip, combining the exam, any remaining tests, the operation and early recovery; an unusually complicated case may need one extra visit, and you would know before booking anything. The how many trips section of the travel guide has the detail.

For most Puna patients, the operation is at Hilo Community Surgery Center, Dr. Morton’s surgical venue in Hilo. It is a same-day setting with no overnight beds, so the plan from the beginning is to head back toward Pāhoa, Mountain View or Volcano the day of surgery, once you are steady with a walker, keeping food and fluids down, and your pain is controlled by tablets. Discharge follows those milestones, not the clock.

Anyone who might need a night of hospital monitoring, and anyone facing a complex or infected revision, is scheduled at a hospital on O‘ahu instead, such as The Queen’s Medical Center, where infection decisions are made with infectious-disease specialists. Wherever it happens, Dr. Morton performs your operation himself. Other parts of the day belong to the wider team: anesthesia providers place your nerve blocks, nurses prepare and monitor you, and his physician assistant may handle some visits, though you can always ask to see Dr. Morton.

Following a Hilo operation, the usual answer is not long at all: discharge is the same day. From the far end of lower Puna or from Volcano, though, the ride home can feel long on that first day. If that worries you, ask the team before surgery whether resting closer to Hilo for the first night makes sense. Either way, your companion should be with you around the clock for the first 24 to 72 hours or longer, and brings you back for your first follow-up around a week later.

If your operation is on O‘ahu, expect about 10–14 days near the surgical facility before flying home, enough to get past the first check after the operation. The exact day depends on the team’s fit-to-fly clearance, so buy a ticket you can change. The lodging section of the travel guide covers choosing where to stay.

Rehab starts on day one or two at home, and it can happen in Puna rather than Hilo if a therapist there suits you. Some people begin with home visits; others go to a clinic. Choose any licensed physical therapist that is practical from where you live, and the office will send Dr. Morton’s rehabilitation protocols to them directly. If you have nobody in mind, ask the office for names close to home.

You will be a passenger for a while: driving waits until you no longer need narcotic pain medicine and can stamp on the brake without hesitation, on average two to six weeks. A therapist close to home keeps those rides short for whoever is driving you from Pāhoa or Mountain View. Video check-ins let the team adjust your program without another trip to town, and the knee recovery guide shows what each stage of a knee recovery looks like.

For Puna patients whose surgery is on O‘ahu, the flight home is booked around clearance, not a date. You fly only after the surgical team says you are fit to, never on the day of surgery. When you book, ask the airline for wheelchair or cart assistance. On the plane, pick an aisle seat, stand and walk when it is allowed, keep drinking water, and pump your ankles while seated. Stay on the clot-prevention medicine you were prescribed, without adding extra aspirin because you are flying.

Most likely, the metal detector will notice your implant. Tell the officer which side was replaced; no card is required and screening cannot hurt the joint. Plan the last leg too: after landing on Hawai‘i Island there is still the drive back to Puna, so line up someone to meet you at the airport. The flying home section goes over the details.