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

Leaving Moloka‘i for an operation takes planning, a companion and time away, so the reason should be clear before anyone books a seat. For many patients it is a hip or knee worn past what therapy, medication and injections can manage. For others it is an older replacement, sometimes put in on the mainland or abroad, that has started to ache, grind or feel unsteady.

Revision cases sent by other surgeons fill roughly half of Dr. Morton’s practice, and implants placed elsewhere are routine at his Revision Hip & Knee Clinic. His fellowship in hip and knee reconstruction was at the University of Chicago, and he is a Kea‘au native who came home to Hawai‘i to practice. He leads the surgical decisions and does the operation with his own hands; a physician assistant, nurses, the anesthesia team and therapists may look after other parts of the pathway. Dr. Morton’s biography covers his training in full.

Surgical choices are mostly settled on the video call, so the ticket is bought for a known operation. For a knee, it starts with where the wear is. Damage limited to a single compartment, in a knee with a working ACL that still straightens, may suit a partial knee replacement; arthritis spread through two or three compartments calls for a total. Totals are done with the quad-sparing subvastus approach in all but a few knees, and primary knees are done tourniquet-free. For a hip, the usual route is direct anterior: the muscles stay attached and only the capsule of the joint is opened. If earlier hip surgery, retained hardware or a significant deformity makes that riskier, he will recommend another approach.

Robotic guidance on O‘ahu depends on the case and the hospital, and the robot carries out his plan rather than making choices. If you already have a replacement, the first decision is a diagnosis, not an implant. His reasoning is laid out in his joint replacement philosophy.

On Moloka‘i, that review decides whether a flight is needed at all. It happens at your first appointment, a telehealth consultation: a text from the office brings a Doximity link, you open it on your iPhone or Android phone at home, and Dr. Morton goes through your films with you on screen.

Standing X-rays ordered near home are the usual starting point. MRI is held back until a specific question needs it. Hawai‘i studies can generally be pulled in electronically. If you have older images on a disc or from a mainland surgeon, you are welcome to upload your images (opens in a new tab) before the call. Uploading only stores the files; it is not a review and books no appointment.

For an existing replacement, send the operative note and implant card if you have them, plus the actual image files, not only the written reports.

Much of the preparation happens on Moloka‘i:

• Clearance: your own primary care provider usually signs off on your health. Dr. Morton and the anesthesia team then go over your heart, lungs, medicine list and past anesthetics.
• Testing: depending on your health, blood work and an EKG. The office lists what you need and can book it; ask whether it can be done on Moloka‘i.
• Getting ready: a dentist visit ahead of surgery, quitting smoking or vaping (1-800-QUIT-NOW can help), and an A1c goal agreed with your doctor if you have diabetes.
• Coverage: the office checks whether an HMO, managed-care or Medicaid/Quest plan needs a referral, and whether your plan offers interisland travel assistance. Some Hawai‘i plans help with airfare and lodging when off-island care is medically necessary.
• Flights: mention the walker and request wheelchair or cart help when you book the return.

Each step is explained in the guide to traveling for joint replacement.

For most Moloka‘i patients, one. Video, local X-rays and your own doctor’s clearance replace the early flights, which leaves one O‘ahu trip to carry four jobs: your in-person exam, the remaining pre-operative tests, surgery, and early recovery, with most travelers staying near the Ala Moana clinic. You are always examined in person before an operation, and doing it on the surgical trip saves a separate round trip from Ho‘olehua.

Some cases need more. A complex revision, or an infection treated in stages, may add a visit, and that is spelled out before any ticket is bought. Air service from Moloka‘i is generally on small commuter planes, with fewer departures than the larger islands have, so book early and choose fares you can change. Your return date follows your recovery, not the calendar.

Moloka‘i patients have their operations on O‘ahu, at The Queen’s Medical Center in Honolulu or Adventist Health Castle in Kailua. Queen’s is the state’s largest hospital and a Level 1 trauma center. Revisions, complex reconstructions and patients carrying more medical risk usually go there; ROSA® robotic assistance is on hand, and The Joint Commission has given Queen’s Advanced Certification in total hip and total knee replacement. Castle provides hip and knee replacement in a hospital setting on the Windward side.

The venue is chosen with you, by procedure, health and insurance. If you qualify for same-day surgery, going home that night means going back to your O‘ahu room with your companion; if your health calls for monitoring, you stay overnight in the hospital instead. Revisions are booked at a hospital and generally involve a brief inpatient stay.

Set aside roughly 10–14 days for the O‘ahu stay after a joint replacement. It covers your first post-operative visit, at about one week, and lasts until the surgical team signs off on the flight back to Moloka‘i. Use it as a planning range, not a promise: the team’s fit-to-fly clearance picks the day, and a smaller procedure often takes less time.

Traveling patients usually book a hotel room or condo near the Honolulu clinic, often in the Ala Moana–Waikīkī corridor. Look for an elevator, flat walking routes, room for your companion, and ADA compliance. After surgery is scheduled, the care coordinator can pass along recovery-friendly options, though the practice is not affiliated with any of them. Book it all yourself, or let the Elite Recovery level of the Rapid Recovery Concierge organize flights, lodging and O‘ahu transport; you still pay the travel costs. See the travel guide for more.

Therapy usually begins near the clinic while you are still on O‘ahu, and the Honolulu clinic has physical therapists in-house. Back on Moloka‘i, any licensed physical therapist you choose can take over the program.

Settle the details before surgery. Ask the office which therapists it can suggest near you and how Dr. Morton’s written rehabilitation protocols will reach the one you choose. If finding a therapist you can get to from Kaunakakai, Ho‘olehua or the East End turns out to be hard, raise it early so the team can plan with you.

Video visits keep going after you return: the team can look at your incision through the camera and change your exercises without another flight. Expect to lean on a walker through roughly the first couple of weeks before stepping down to a cane as your balance improves.

The flight home to Ho‘olehua comes only once the surgical team clears you, and never on surgery day. Flights from Moloka‘i are generally on small commuter planes, so a few habits matter:

• Confirm the wheelchair or cart assistance you requested when you booked.
• Pack light and let your companion carry the bags; your hands belong on the walker.
• Pump your ankles in your seat, drink water, and walk while you wait.
• Stick to your prescribed clot-prevention plan; the flight is no reason for extra aspirin or another blood thinner.

If your route home passes through airport security, the new joint will likely set off the metal detector. Security needs no implant card or doctor’s letter. Tell the officer which joint was replaced, for instance “my right hip is a replacement,” and a wand or short pat-down follows; none of it can affect the implant. The airport screening guide has the details. Arrange your ride home from Ho‘olehua before you leave O‘ahu.