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

A second opinion from Kāhala usually starts in one of two places. The first is a new recommendation for a total knee, when what you want to know is how soon you will be back on the course or the court, and whether anything smaller was weighed. The second is a joint replaced years ago, sometimes on the mainland or overseas, that has never felt quite stable or has begun to ache again.

Either way, Dr. Morton studies the images themselves, not only the radiologist’s summary, examines you, and puts what he finds into a written impression with your options, usually within one to two weeks. Plenty of people take that document back to the surgeon they already see; nobody expects you to switch. The second opinion page lists what to gather, and replacements already in place go through the Revision Hip & Knee Clinic. His fellowship training is set out on the about Dr. Morton page.

A knee that rotates through a golf swing or pushes off for a drop shot depends on the quadriceps, and protecting that muscle group is where Dr. Morton begins. On nearly every total knee he uses the subvastus approach, lifting the vastus medialis and working underneath it, so the tendon that straightens the knee is never divided. He sets it aside for knees that are very muscular or tight, badly deformed or scarred from earlier surgery, and for most revisions. Every first-time knee is done tourniquet-free.

The implant is positioned to match the alignment and ligament balance of your own leg, inside published safe-zone limits; the long-term record for that method is still accumulating. Strong bone gets cementless parts, weaker bone gets cement, which has the longest track record, and the choice is made on X-ray, confirmed in the operating room, and covered by your consent to both. Commonly, a knee implant lasts 20 years or more. The return-to-sports guide sorts activities by impact.

Direct anterior is Dr. Morton’s standard hip operation. Working from the front between muscles, he opens only the capsule and leaves every muscle attached to bone, so most people go home without a list of hip precautions, which is useful when your goals include bending to tee up a ball or stepping off the sand into the water. Earlier hip surgery, retained hardware, significant deformity, a large overhanging skin fold or poor wound healing can make another approach safer, and he tells you when that applies.

A bikini-line incision is offered when your anatomy allows, a good fit if you would like the scar to sit under swimwear. If he needs more room, he lengthens it into a standard anterior incision instead of accepting a less accurate implant position. Most hips receive a titanium cup, a cross-linked polyethylene liner and usually a ceramic head; dual mobility is held back for hips at higher risk of dislocation.

If your pain sits on one side of the knee and flares during a round or a match, the partial question deserves a proper answer. A partial replaces only the damaged compartment. It suits arthritis limited to that area, an intact ACL, a knee that still straightens well, mild deformity that can be corrected, and pain that has lasted through therapy, medication and injections. Two or three worn compartments, a torn or absent ACL, inflammatory arthritis such as rheumatoid arthritis, or severe deformity rule it out.

Dr. Morton performs medial, lateral, patellofemoral and bicompartmental partials, each planned in 3D and done with robotic assistance through a smaller incision, with no tourniquet. The catch: over a lifetime, a partial is somewhat more likely to be revised, and turning it into a total, while usually more straightforward than redoing a failed total, still counts as a revision. Age alone does not settle it; standing X-rays and the exam do. See partial knee replacement and his reasoning.

If you have Medicare, a fair first question is whether the robot changes what you are billed. It does not. Robotic assistance is billed as standard joint replacement, without a technology fee or any separate patient charge, and your Medicare coverage is the same with or without it.

Dr. Morton draws up a 3D plan before surgery; in the operating room the system follows that plan and feeds back alignment and balance as he works, but it never makes a cut by itself and makes no decisions. On O‘ahu the platform depends on your case and the venue, and at Queen’s it is ROSA®, which works from standard X-rays, with no CT scan. He is certified on ROSA, Mako, CORI and VELYS. For a hip, the plan sets cup angle, stem size, offset and leg length, and X-rays in the operating room check leg length, since a robot cannot promise that both legs will match. More on robotic hip replacement.

A replaced hip that slips out of joint, or a knee that buckles when you plant to change direction, is instability, and it is one of the problems Dr. Morton’s revision work exists to solve. About half of his practice is revision surgery referred by other surgeons, and his clinic regularly evaluates implants placed elsewhere. He also checks for loosening, infection, wear with bone loss, fracture around the implant, metal debris reaction, stiffness and malposition.

Nothing is revised without a reason. The workup sets new X-rays beside older ones, adds blood work for ESR and CRP, an aspiration with culture when infection is possible, CT or a metal-artifact-reduction MRI when needed, and identification of the exact implant, recall status included. Instability is then addressed through implant and bearing choices, such as a dual-mobility bearing in a hip or a more constrained design in a knee. Every revision is scheduled at a hospital, usually Queen’s, and usually involves a short inpatient stay. See revision hip replacement.

Your consultation is at the Honolulu clinic facing Ala Moana Center, where you park inside the building. Standing X-rays can be taken during that appointment. Carry your photo ID and insurance card, a list of your medications, and whatever earlier imaging, operative reports or implant records you have. With traditional Medicare or a PPO you can generally book directly; managed-care plans may need a referral, which the office checks first. Phone (808) 439-6201 on weekdays between 8:00 am and 4:30 pm HST, or tap Schedule to book online; most new patients get an appointment within one to two weeks.

Your operation takes place at The Queen’s Medical Center or Adventist Health Castle, a choice made together based on the procedure, your health and your insurance. Dr. Morton sets the surgical plan and performs the operation himself; Justin Grandalen, PA-C, who works beside him in clinic, along with nurses, therapists and anesthesia providers, looks after other parts of your care.

Going home is decided by milestones, not the clock: you leave once you walk safely, eat and drink, and your pain is controlled on pills, with someone staying at least the first night. A walker is the usual support for the first couple of weeks or so, then a cane. Therapy starts on your first or second day home, in the in-house gym at Ala Moana or with any licensed physical therapist nearer Kāhala, who receives Dr. Morton’s written protocols. You are seen around one week after surgery, some later checks can be done by video visit, and an X-ray each year watches the implant.

Water and sand come back in stages. A knee stays out of the pool and the ocean until the incision is healed and you are cleared, typically at six weeks. A hip can usually start pool swimming once the incision is sealed and you are cleared, commonly around a month, with ocean swims nearer three months. Loose sand shifts underfoot, so firm paths come before a long beach walk.