Hip & Knee Replacement for Patients in ‘Āina Haina, Hawai‘i

Two situations make a second opinion worth the drive in from the valleys. You have been offered a joint replacement and want certainty before arranging time off work, or you already have a replaced joint, done here or elsewhere, that has started to hurt, and an X-ray report mentions bone loss. In either case the value lies in a surgeon looking at the actual images and examining you, not just reading what someone else wrote.

Dr. Morton re-reads your films himself and gives you his view and your options in writing, generally inside one to two weeks. Whether you go ahead with him or with your own surgeon is your decision. You probably do not need an MRI first: the exam and weight-bearing X-rays lead, and an MRI is added only when a specific question remains. The second opinion page covers what to bring, and his fellowship training in complex revision is described on the about Dr. Morton page.

Heading down a sloped driveway, your quadriceps acts as a brake on every step. Dr. Morton protects that muscle on nearly every total knee with the subvastus approach: the vastus medialis is lifted aside and the quadriceps tendon is left uncut. When a knee is very tight or very muscular, badly deformed or scarred by an earlier operation, and in most revisions, another route is the better choice. Primary knees are all done tourniquet-free.

Implant position follows your anatomy. Personalized alignment matches the components to your leg’s alignment and ligament balance while staying inside published safe-zone limits, and durability data for the method are still accumulating. Your bone decides fixation: cementless components where X-rays show good quality, confirmed during surgery, and cement, the most established option, for weaker bone, with your consent covering both. A knee implant commonly lasts 20 years or more. Read about robotic knee replacement.

If a desk job is waiting, a hip usually allows the quicker return of the two. Dr. Morton’s standard is direct anterior: the hip is reached from the front, the muscles are worked between rather than cut, and only the capsule is opened, so in most cases there are no hip precautions limiting how you sit at a desk or get into the car. Previous hip surgery, hardware still in the bone, significant deformity, a large overhanging fold of skin or wounds that heal poorly can make another approach the safer one, and he explains when that applies to you.

When anatomy allows, the incision can follow the bikini line; if he needs more access, he extends it to a standard anterior incision rather than compromise implant position. The usual hip is a titanium cup with a cross-linked polyethylene liner and, most often, a ceramic head, cementless where bone allows, with dual mobility saved for higher dislocation risk. The hip replacement overview has more.

Partial candidacy is settled by standing X-rays and an exam, both done at the first visit, so it rarely needs a trip of its own. A partial needs arthritis confined to one compartment, the ACL to be intact, the knee to straighten well and any deformity to be mild and correctable, and the pain should have held out against therapy, medication and injections. When two or three compartments are involved, the ACL has failed, the arthritis is inflammatory (rheumatoid, for example) or the deformity is severe, a total is the answer.

Dr. Morton performs every type of partial, from medial and lateral to patellofemoral and bicompartmental, each planned in 3D and done with robotic guidance through a shorter incision, tourniquet-free. What you give up: across a lifetime, partials are revised a little more often. Should yours ever become a total, that operation is generally easier than redoing a failed total, yet it is still a revision. Age alone is not the test. See his reasoning on partial versus total.

The robot does not operate; Dr. Morton does. Before surgery he plans your implant in 3D, and in the operating room the system helps him execute that plan while reporting alignment and balance. It makes no cuts on its own and no decisions. Which robot is used on O‘ahu depends on the case and the hospital; Queen’s runs ROSA®, which builds its plan from standard X-rays, so no planning CT scan is required. He holds certification on four systems: Mako, ROSA, VELYS and CORI.

For hips, robotic guidance is used in essentially every case, setting the cup’s position, the stem’s size, and the offset and leg length, while standing and sitting X-rays of the spine can personalize the cup angle. Even so, leg length is confirmed on X-ray in the operating room, since robotics cannot guarantee it. The robot is billed as part of a standard joint replacement: no technology fee, no separate patient charge, and no change to Medicare coverage. See robotic hip replacement.

Bone loss around an implant usually builds quietly. Wear debris can trigger osteolysis, a gradual dissolving of bone, that hurts little until it is advanced. Revision referred by other surgeons makes up roughly half of Dr. Morton’s practice, and implants put in elsewhere are a regular part of his clinic’s work, so a replacement you did not have with him is familiar ground.

Nothing is revised without a cause. The workup lines up current and earlier X-rays, checks ESR and CRP, adds an aspiration with culture when infection is possible, and uses CT or metal-artifact-reduction MRI to map bone and soft tissue when needed. Your implant is identified, including recall status. Missing bone is then restored with porous metal augments and cones or sleeves, with revision stems long enough to find solid bone. Revisions are planned at a hospital, usually Queen’s, generally with a short inpatient stay. For details, see revision hip replacement or the Revision Hip & Knee Clinic.

All three valleys empty onto Kalaniana‘ole Highway, and morning traffic toward town is part of the trip. When you book, ask for an appointment time that suits the drive. You are seen at the Honolulu clinic, which faces Ala Moana Center and has parking in its building, and standing X-rays are taken there during the visit. The office answers (808) 439-6201 on weekdays from 8:00 am until 4:30 pm HST; online booking is under the Schedule button, and new patients typically get in within one to two weeks.

If surgery follows, pre-operative tests such as blood work or an EKG may be needed; ask whether yours can be done near home. The operation itself happens at The Queen’s Medical Center, or at Adventist Health Castle in Kailua if that fits your case better, chosen with you by procedure, health and insurance. Surgical decisions and the operation are Dr. Morton’s; Justin Grandalen, PA-C, nurses, physical therapists and anesthesia providers cover other parts of the pathway.

On a same-day discharge, someone else drives you back up the valley, and the sloped driveway and front steps are the first obstacles. Plan for them before surgery: a handrail at the steps, a clear path from where the car stops, and a companion staying at least the first night. Expect a walker from surgery day for roughly the first couple of weeks, then a cane once your balance allows.

Rehab begins almost at once, on the first or second day after you return home. You can use the in-house gym at Ala Moana or any licensed therapist nearer the valley, who works from Dr. Morton’s written protocols. You return for a first check about a week after surgery, and an X-ray every year after that watches the implant. The ridge trails above the valleys come later: trails in general return around three months, and steep, long or technical climbs belong later in the first year, so ask at follow-up where Wiliwilinui or Kuli‘ou‘ou fits for you.