Hip & Knee Replacement for Patients in Hawai‘i Kai, Hawai‘i

From Hawai‘i Kai, a second opinion has to earn the drive into town, and it tends to in two situations. One is a recommendation for surgery that never asked what you want the joint to do, whether that means the crater stairs, a ridge trail or paddling. The other is a hip or knee that was already replaced and still hurts, or that turned painful after a stretch of feeling fine.

Dr. Morton looks at the films with his own eyes, not just the radiology report, examines you, and puts his view and the choices in writing, generally inside one to two weeks. That document is yours to share with your own surgeon. To make the trip count, have the actual images sent, or upload your images (opens in a new tab) ahead of the visit. The portal is storage only: it does not count as a review and does not book an appointment. The second opinion page lists what else helps.

Coming down a stair trail loads a knee harder than going up, and a quadriceps that works well is what controls each step down. That is part of why Dr. Morton reaches nearly every total knee from beneath the vastus medialis, the subvastus route, instead of cutting into the quadriceps tendon. Knees that are very tight or heavily muscled, those with significant deformity or scarring from earlier surgery, and most revisions are handled another way. He does not use a tourniquet on any primary knee.

Alignment is personal. The implant is placed to suit your leg’s natural alignment and ligament balance within published safe-zone limits, and long-term data on that method are still coming in. Fixation follows your bone: good bone quality on X-ray points to cementless parts, confirmed at surgery, while weaker bone is cemented, the option with the longest track record, and you consent to both. A total knee incision usually runs 4–6 inches. The knee replacement overview has more on the operation.

Climbing into a canoe, stepping aboard a boat at the marina and taking stairs all ask a hip to bend and rotate. With the direct anterior approach, which is Dr. Morton’s standard, the joint is reached from the front between muscles, only the capsule is opened and no muscle is detached, so in most cases you are not handed a list of positions to avoid. He switches approach when earlier hip surgery, hardware left in place, significant deformity, a large skin fold overhanging the groin or slow wound healing makes another route safer, and he will say so.

If you want the scar under swimwear, a bikini-line incision is an option when anatomy allows; if he needs more exposure, he extends it rather than settle for a less accurate implant position. Most hips pair a titanium cup, fixed without cement where bone allows, with a liner of cross-linked polyethylene and, in most cases, a ceramic ball. Patients at higher risk of dislocation may get a dual-mobility bearing.

When the pain lives on one side of the knee, a hiker will reasonably ask whether the whole joint needs replacing. A partial resurfaces just the worn compartment. It is meant for wear limited to that compartment, an intact ACL, a knee that extends well, mild correctable deformity, and pain that has persisted despite therapy, medication and injections. Damage in more than one compartment, a failed ACL, rheumatoid or other inflammatory arthritis, or severe deformity call for a total.

Dr. Morton does all four types: medial, lateral, patellofemoral and bicompartmental. Each is mapped out in 3D beforehand, then done with robotic help through a shorter incision and no tourniquet. The trade-off: across a lifetime, partials need revision somewhat more often, and converting one to a total, though usually less involved than redoing a failed total, is still a revision. Age on its own does not decide; standing X-rays and the exam do. Compare the two on the total vs partial page.

For a knee that has to carry you down a stair trail, the aim is alignment and ligament balance that hold up through the full bend. Robotic planning gives Dr. Morton live measurements of both. He lays out the implant positions in a 3D plan before surgery; during the operation the robot keeps him to that plan and reports alignment and balance so he can adjust. It does not cut on its own and makes no decisions. On O‘ahu the system is matched to your case and the hospital, and at Queen’s that means ROSA®, planned from standard X-rays.

He is certified on four platforms: ROSA, Mako, CORI and VELYS. Hips receive robotic guidance in essentially every case, the plan setting where the cup sits, which stem size fits, and the offset and leg length; spine X-rays taken standing and sitting can tailor the cup target to you. Leg length is still checked on X-ray during surgery, because robotics cannot guarantee it. See robotic knee replacement.

A replaced joint that hurts deserves a diagnosis before anyone discusses another operation. The possible causes run from loosening, infection and instability to wear with bone loss, a fracture near the implant, a reaction to metal debris, stiffness from scar tissue and components in the wrong position. Sorting them out means comparison X-rays, ESR and CRP, an aspiration with culture, and CT or metal-artifact-reduction MRI when the answer is still unclear. Dr. Morton does not revise a joint without a reason.

With infection, timing matters most. Caught early, an infected joint can sometimes keep its implant through debridement, antibiotics and a liner exchange, known as DAIR. A chronic infection usually calls for a two-stage revision, while a single-stage exchange fits selected cases. Those decisions are made with infectious-disease specialists and hospital resources at Queen’s. A replaced joint that suddenly turns painful after being comfortable is worth a prompt call. The infected knee replacement page explains the options.

Every appointment in town begins on the same stretch of Kalaniana‘ole Highway, so the first visit is set up to do as much as it can at once. At the Honolulu clinic across from Ala Moana Center, with parking in the building, standing X-rays are taken during the consultation. Because an MRI is usually not needed first, the exam and those films are often enough to talk through your options that day. Imaging from elsewhere in Hawai‘i can usually be retrieved electronically. Call (808) 439-6201 or book through the Schedule button; most new patients are seen within one to two weeks.

Surgery is at The Queen’s Medical Center in Honolulu or Adventist Health Castle in Kailua, picked together on the basis of your procedure, health and insurance. Queen’s is the usual setting for revisions and patients with higher medical risk. The surgical decisions and the operation itself are Dr. Morton’s; Justin Grandalen, PA-C, nurses, therapists and anesthesia providers take care of other parts of the pathway.

Plan the first weeks around fewer trips. Most people are up and walking on surgery day, leaning on a walker at first and trading it for a cane as your balance returns, usually after the first couple of weeks. Physical therapy begins on the first or second day home, in-house at Ala Moana if you like, or with any licensed therapist closer to Hawai‘i Kai, who receives Dr. Morton’s written protocols from the office. The first follow-up is around one week after surgery. Later wound checks and progress reviews can happen by telehealth on Doximity: the office texts a link and you join on an iPhone or Android phone, which spares a round trip on Kalaniana‘ole.

Most people take aspirin for several weeks to prevent clots, and some higher-risk patients are given a prescription blood thinner; follow whichever plan you are given exactly. A yearly X-ray then watches the implant for life. The first year after hip replacement guide maps the months ahead, including the return to the water.