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

For a Makiki patient, a second opinion turns on the imaging. You may have X-rays showing arthritis and a surgical recommendation you are unsure about. Or you had a hip or knee replaced years ago and have now been told the films show loosening or bone loss, with a revision suggested. Both situations deserve a careful look before anything goes on the schedule, and the answer is sometimes that the original plan is right.

Dr. Morton re-reads the films himself and sets them beside any earlier studies, then writes up what he finds and the choices open to you, in one to two weeks as a rule. That write-up belongs to you; take it back to your current surgeon if you prefer to stay there. The images themselves matter more than a summary, and studies done in Hawai‘i can usually be retrieved electronically. No operation is booked without an in-person exam. The second opinion page describes the process, and the revision clinic handles questions about joints that were already replaced.

Stairs are the first real test for a new knee in a Makiki walk-up. Nearly every total knee Dr. Morton performs uses the quad-sparing subvastus approach: rather than splitting the quadriceps tendon, he slips beneath the vastus medialis, leaving intact the muscle you depend on to step up. In randomized trials, subvastus patients raised a straight leg sooner and scored lower pain on the first day; results even out after the first few months. Knees that are very muscular, tight, significantly deformed, scarred or being revised usually need wider exposure.

Every primary knee is done without a tourniquet. Implant position follows your natural alignment and ligament tension, within published safe-zone limits; durability data for this personalized alignment are still accumulating. If bone quality allows, the implant goes in without cement, a decision made on X-ray and confirmed at surgery; weaker bone is cemented, the method with the longest history, and you consent to both. A knee implant commonly lasts 20 years or more. See the knee replacement hub.

Hip patients face the same climbs. Dr. Morton’s standard is the direct anterior hip: the joint is reached from the front without cutting or detaching any muscle, only the capsule is opened, and most patients are not handed a list of hip precautions. Steps and car seats then follow what feels steady, not a list of forbidden positions. He picks another approach when that is safer: after previous hip surgery, with hardware still in the bone, with major deformity, a large fold of skin over the groin, or wounds that have healed poorly before.

A bikini-line incision is possible when anatomy allows; if more exposure is needed, it becomes a standard anterior incision. Typical components are a titanium cup and a cross-linked polyethylene liner with, usually, a ceramic head, set without cement where bone allows, and dual mobility only for higher dislocation risk. Brand never drives the choice. Leg length is planned beforehand and confirmed on intraoperative X-rays, but no technique can guarantee it; the leg length page explains why.

Whether a knee needs a partial or a total is settled by standing X-rays and a hands-on exam; an MRI is added only when a specific question remains open. A partial fits when the arthritis stays in one compartment, the ACL is intact, the knee straightens well, any deformity is mild and correctable, and therapy, medication and injections have not controlled the pain. A total is the better fit when wear has reached two or three compartments, the ACL is torn or missing, the arthritis is inflammatory, as with rheumatoid arthritis, or the deformity is severe.

Dr. Morton performs all four partial types, lateral, patellofemoral, medial and bicompartmental, each planned in 3D and performed robotically, tourniquet-free, through a shorter incision. The catch: across a lifetime, partials come back for revision somewhat more often, and switching one to a total counts as a revision too, though generally an easier one than redoing a failed total. Age alone does not make the call. The partial knee page goes into candidacy.

Robotic planning also raises an imaging question: will I need a CT scan? On O‘ahu, the platform is matched to each case and venue. At Queen’s, ROSA® plans from standard X-ray images, and no CT is required. Mako, which Dr. Morton uses at Hilo Community Surgery Center on Hawai‘i Island, plans from a CT scan instead. He is certified on CORI and VELYS as well.

Whatever the system, the robot carries out the 3D plan he sets and reports alignment and balance in real time. It never makes a cut on its own or a decision for him, and he performs the whole operation. Essentially every hip gets robotic guidance as well, covering cup position, stem size, offset and leg length, and spine X-rays taken standing and sitting can tailor the cup target. The robot adds no separate patient fee and leaves Medicare coverage unchanged. Read more about ROSA and Mako.

Joints replaced years ago can loosen quietly. As the plastic liner wears, it sheds tiny particles, and the body’s reaction to them can dissolve the bone around the implant, a process called osteolysis, until the components lose their grip. Loosening may bring start-up pain when you rise from a chair, new groin or thigh pain, or a knee that turns painful or swollen after a comfortable stretch. It can also be silent, showing only on X-rays, which is why implant surveillance includes a yearly film.

Nothing is revised until the cause is proven. New X-rays are set against old ones, ESR and CRP blood work screens for infection, aspiration with culture follows when infection is a possibility, metal-artifact-reduction MRI and CT scans are added when required, and the implant model and recall status are confirmed. Lost bone is rebuilt with porous metal augments, cones or sleeves, and longer revision stems that reach solid bone. Revisions take place at a hospital, usually nearby Queen’s, usually with a short inpatient stay.

Makiki sits close to both stops on the way. Your consultation, standing X-rays, therapy sessions and post-operative checks happen at the Honolulu clinic opposite Ala Moana Center, which has parking in its building. Surgery is at Queen’s, also nearby, or, when your case or insurance points that way, at Adventist Health Castle in Kailua; the location is decided with you. Reach the office at (808) 439-6201 on weekdays, or use the Schedule button online. New patients usually get an appointment within one to two weeks.

Dr. Morton decides on and performs the surgery himself; physician assistants, nurses, physical therapists and anesthesia providers carry much of what happens around it. After surgery, some check-ins can happen by video on Doximity: the office texts you a link you can join from an iPhone or Android phone, so a wound check or progress review does not have to mean a trip down the stairs early on. An in-person exam always comes before surgery itself.

Getting home to a walk-up starts before surgery. Prehab can include practicing stairs with a walker or cane, and on surgery day a physical therapist clears you on the skills you need at home, stairs included. Discharge waits until you can walk safely, keep food and fluids down, and control pain with pills. On flat ground, expect a walker for roughly the first couple of weeks and a cane after that as your balance firms up; on stairs, follow the technique your therapist teaches you.

Outpatient therapy begins on day one or two at home, at the clinic’s in-house PT gym or with any licensed therapist near Makiki, and the office sends Dr. Morton’s written rehab protocols to whoever you choose. Your first follow-up comes about a week after surgery, and yearly X-rays follow for the life of the implant. When trails return, generally around three months, the Makiki Valley trails above the neighborhood are close at hand; steep or long routes wait until later in that first year.