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

Often the visit begins with a sentence somebody else said: “You need a total knee,” or “Your implant looks loose.” Either may be correct. A second opinion tests the statement against the films and the exam before you commit to a surgery date. With a knee, Dr. Morton asks whether the arthritis really involves the whole joint or sits in one compartment, and whether nonsurgical options have had a fair trial. With a replaced joint, he looks for what has actually changed on X-ray over time.

He studies the images personally rather than relying on the written report, then sets out his impression and your choices in writing, usually within one to two weeks. Many people take that back to their original surgeon and carry on there. Send the films themselves, or upload your images (opens in a new tab) ahead of the appointment; the portal keeps them ready for the visit but is not a review in itself and schedules nothing. The second opinion page walks through the process.

Each trip up the front steps is a small leg press, and the quadriceps does most of the lifting. Dr. Morton’s approach on nearly every total knee is the subvastus: he raises the vastus medialis and passes beneath it, so the quadriceps tendon is never cut. Published trials show the gain early, with an earlier straight-leg raise and less pain on day one, while long-term durability is unchanged. Tight or very muscular knees, significant deformity, scarring from previous surgery and most revisions get a different approach, and every primary knee is done without a tourniquet.

The components are aligned to your own leg and balanced to your ligaments, inside published safe zones, though the method’s long-term record is still building. Whether they are cemented depends on your bone: cementless where X-rays and the operating room confirm good quality, cement where bone is weaker, cement being the option with the longest record. You consent to either. Knee implants commonly last 20 years or more. See the knee replacement hub.

With steps at the door and a car to fold into on a narrow street, a hip that comes home without a list of forbidden positions is a real advantage. For hips, Dr. Morton’s default is the direct anterior approach, done from the front between muscles; only the joint capsule is opened and no muscle comes off bone, so most people have no hip precautions to follow. Prior hip surgery, retained hardware, marked deformity, a heavy skin fold over the groin or a history of poor healing can tip the balance toward a different approach, and when they do, he says so and why.

A bikini-line incision is possible when anatomy allows, and he lengthens it into a standard anterior incision if the implant needs more room. The implant set is usually a titanium socket shell lined with cross-linked polyethylene, plus a ceramic ball in most cases, fixed without cement when bone allows. Dual mobility is reserved for people more likely to dislocate. Brand preference never decides the implant.

Heard “total knee” already? Ask what your standing X-rays show in each compartment. A partial swaps out only the worn section. It is designed for a knee whose arthritis has stayed in a single compartment, whose ACL is still sound, which still extends well, where deformity is mild and correctable, and where therapy, medication and injections have stopped helping. Wear across two or three compartments, an ACL that is torn or absent, inflammatory disease such as rheumatoid arthritis, or a badly deformed knee rule it out.

All four kinds of partial, medial, lateral, bicompartmental and patellofemoral, are part of Dr. Morton’s practice; each is designed in 3D and placed robotically through a smaller incision with no tourniquet. Over a lifetime a partial is somewhat likelier to need another operation, and although converting it to a total is usually less complex than revising a failed total, it still counts as revision surgery. Age does not decide it; the X-rays and the exam do. The total vs partial comparison lays out both.

Robotic assistance is a measuring and guiding tool, not an autopilot. Before surgery Dr. Morton builds a 3D plan for your joint. In the operating room the robot helps carry out that plan and gives him live readings of alignment and balance, while he performs every step; the machine never cuts by itself and decides nothing. Which platform is used on O‘ahu depends on the case and the venue. Queen’s uses ROSA®, working from plain X-rays with no CT scan needed, and he holds certification on ROSA, Mako, CORI and VELYS.

Hips are planned robotically in essentially every case, from where the cup sits to the stem size, offset and leg length. X-rays of the spine taken standing and sitting can refine the cup target, and leg length is checked on X-ray during the operation, since robotics cannot guarantee equal legs. There is no separate fee for the robot, and it does not alter Medicare coverage. Read about ROSA robotic joint replacement.

Loosening means the bond between implant and bone has failed. It often starts as a thin line on X-ray long before the joint aches, which is why Dr. Morton recommends an X-ray every year for the life of the implant. When it does cause symptoms, pain on first standing up and starting to walk is one of the patterns he asks about. The key test is comparing today’s films with earlier ones.

Infection has to be ruled out before a loose implant is treated as a purely mechanical problem, so the workup adds inflammation markers in the blood (ESR and CRP), a joint aspiration sent for culture if infection is a possibility, and CT or a metal-artifact-reduction MRI if questions remain. The implant is identified by model, size and recall status. If a revision is the answer, Queen’s is the usual hospital, you can expect a short inpatient stay, and loose components are replaced with fixation that reaches solid bone. The implant surveillance and revision knee pages explain more.

Whether you start from Kapahulu, St. Louis Heights or Wilhelmina Rise, the first appointment is at the Honolulu clinic, opposite Ala Moana Center. You park in the building, and if your films are old or missing, new standing X-rays are done during the visit; studies from elsewhere in Hawai‘i can usually be pulled electronically. The in-house PB&J Physical Therapy gym is in the same building. Reach the office at (808) 439-6201 on weekdays, 8:00 am to 4:30 pm HST, or book online, and expect a first visit within one to two weeks in most cases. A later check-in may be a telehealth visit, a Doximity video call joined from your phone.

Operations take place at The Queen’s Medical Center or Adventist Health Castle; which one is settled with you according to the procedure, your health and your insurance. Dr. Morton leads the surgical decisions and performs the operation himself. Justin Grandalen, PA-C, his physician assistant, and nurses, therapists and anesthesia providers carry other parts of your care.

Your rehab gets going a day or two after you are home, and where it happens is your choice. You can use the in-house gym at Ala Moana or pick any licensed physical therapist close to home; the office can suggest names nearby. Either way, your therapist receives Dr. Morton’s written rehab protocols, which move you forward by milestones rather than by the calendar.

A front-wheeled walker is what most people use at first, and it is often arranged through the hospital or your insurance; the mobility aids guide covers the details. Before surgery, measure the doorway and the path from the car to the steps, and clear anything a walker would catch on. You come back for a check around one week after the operation. After that, a yearly X-ray keeps the implant under watch, which matters most for catching loosening early.