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

A common second-opinion story goes like this: a surgeon examined your knee, said “total knee,” and you would like to know whether that is the whole menu before you set aside months of hiking. A second opinion tests the diagnosis against your images and your goals. Sometimes it confirms the total. Sometimes the arthritis turns out to be confined to one compartment and a partial deserves a conversation, or the exam suggests giving nonsurgical options more time.

Another is a knee that was already replaced and still aches on Mānoa’s slopes. Either way, Dr. Morton looks at the pictures personally instead of relying on the written report, and he sets out his conclusions and your options on paper, usually inside one to two weeks. You are free to carry that back to your own surgeon. Studies done anywhere in Hawai‘i can usually be pulled electronically. The second opinion process explains what to send.

“Quad-sparing” matters if your days involve climbing. In the subvastus approach, Dr. Morton lifts the vastus medialis muscle and works beneath it, so the quadriceps tendon, the structure that straightens your knee and drives you uphill, is never divided. He uses it on nearly every total knee. Published trials place the benefit in the early weeks: a sooner straight-leg raise, less first-day pain and better motion at one week. By a few months, knees done either way perform alike. Exceptions: very muscular or tight knees, significant deformity, earlier surgical scarring and most revisions.

No first-time knee is done with a tourniquet. Each implant is positioned to suit your leg’s alignment and ligament balance, within published safe-zone limits, a method whose long-term record is still building. Cementless fixation is used when your bone is strong enough, a call made from X-rays and checked again during surgery; softer bone gets cement, which carries the longest track record. Knee implants commonly last 20 years or more. The philosophy page gives his reasons.

For hips, Dr. Morton’s routine is the direct anterior approach. He works through the front of the hip between muscles, opening only the capsule around the joint, and nothing is detached from bone. Most people go home without the old list of hip precautions, which counts for a lot when the house has steps and the street outside runs uphill. If you have had hip surgery before, still have hardware in place, or have significant deformity, a large skin fold that overhangs the groin, or slow wound healing, another approach may be safer, and he will explain why.

A bikini-line incision along the groin crease is available when your anatomy allows. The usual hip combination is a titanium socket, a liner of cross-linked polyethylene and, in most cases, a ceramic ball, fixed without cement where bone permits; dual mobility is saved for patients at higher risk of dislocation. For hikers, trails generally return around three months after a hip, as they do after a knee. Read more about direct anterior hip replacement.

If you were told “total knee,” it is reasonable to ask whether a partial was ruled out and why. The deciding information comes mainly from standing X-rays and the exam; an MRI is only sometimes added. A partial is designed for arthritis confined to a single compartment, with the ACL intact, a knee that still extends well, deformity that is mild and correctable, and pain that persists despite therapy, medication and injections. It is the wrong tool for two or three worn compartments, a torn or absent ACL, inflammatory arthritis such as rheumatoid arthritis, or severe deformity.

Dr. Morton performs bicompartmental, medial, lateral and patellofemoral partials, all planned in 3D and done robotically through a smaller incision without a tourniquet. The honest downside is that partial knees need revision somewhat more often across a lifetime, and turning one into a total is still a revision, even though it is usually less involved than revising a failed total. Your age is not the deciding factor. The total vs partial comparison goes deeper.

For a knee that has to handle Mānoa’s grades, the robotic plan is about ligament balance as much as alignment. Before surgery, Dr. Morton builds a 3D plan; in the operating room, the robot follows that plan and feeds back live measurements of alignment and balance so he can adjust. The machine does not cut by itself and makes no choices. On O‘ahu, which platform is used depends on the case and the venue; at Queen’s it is ROSA®, which works from ordinary X-rays rather than a CT scan.

He holds certification on four systems, Mako, ROSA, VELYS and CORI, and uses robotic guidance on essentially every hip too, where the plan sets cup angle, stem sizing, offset and leg length. Even with that planning, equal leg length cannot be guaranteed, so X-rays taken during surgery check it. There is no technology fee and no separate charge to you for the robot, and Medicare coverage is the same either way. Read about ROSA robotic joint replacement.

A knee replacement that still hurts months after surgery, or that complains on every walk up or down a valley street, deserves an answer before anyone proposes another operation. The causes Dr. Morton looks for include loosening, low-grade infection, instability, stiffness from scar tissue, wear with bone loss, a fracture around the implant, a reaction to metal debris and components sitting in the wrong position. His rule is simple: no revision without a reason.

The workup usually means fresh X-rays laid beside your older ones, ESR and CRP blood tests, an aspiration and culture if infection is on the table, CT or metal-artifact-reduction MRI if the picture is still unclear, and identifying exactly which implant you have, including whether it was recalled. Any revision is scheduled at a hospital, most often Queen’s, and usually means a short inpatient stay. Other surgeons refer enough revision cases that they make up around half of his practice. The revision knee page explains the reconstruction options.

Leaving Mānoa, you head down out of the valley to the Honolulu clinic in Ala Moana, which faces Ala Moana Center and has parking inside the building. A first visit usually pairs an exam with standing X-rays done on site. Bring a photo ID, your insurance card, a medication list and any earlier imaging or operative reports. Call (808) 439-6201 between 8:00 am and 4:30 pm HST on weekdays, or schedule online; most new patients get in within one to two weeks.

Surgery happens at The Queen’s Medical Center or Adventist Health Castle, chosen with you by procedure, health and insurance. Dr. Morton makes the surgical decisions and does the operation; his physician assistant, Justin Grandalen, PA-C, along with nurses, therapists and anesthesia providers, handles other steps, and you can always ask to see Dr. Morton. For a check-in that needs no hands-on exam, a telehealth visit on Doximity saves the drive on a wet day: the office texts a link you open on an iPhone or Android phone.

Plan for the steps at your door before surgery, clear the walking paths inside, and line up someone who can stay through at least the first night. Most patients are walking on surgery day, with a walker they typically keep for the first couple of weeks or so, until a cane takes over. Therapy begins a day or two after you get home, in the Ala Moana clinic’s in-house gym or with any licensed physical therapist closer to the valley, and the office sends that therapist Dr. Morton’s written rehab protocols. Ask your therapist to rehearse the exact steps and slopes you face at home.

Your first follow-up is about one week after surgery, with a yearly X-ray from then on to watch the implant. Rain matters too: wet steps and sloped driveways deserve extra care while you are still on a walker or cane, and later, two trekking poles help on slick trail descents. The hiking guide and the knee recovery timeline lay out the stages.