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

Joint replacement means time away from the car, and for many people from work, so it is worth being sure the plan is right before you block out those weeks. One reason to ask for a second look is a recommendation for a total knee when you suspect only one part of the knee is worn. Another is a hip or knee replaced elsewhere, perhaps by a surgeon who has since retired or moved away, that now hurts or may be infected.

Dr. Morton re-reads your images personally rather than relying on reports, goes through the operative records and implant details, examines you, and writes up a clear impression with options, typically within one to two weeks. Provide the images themselves, plus operative notes. Hawai‘i studies can usually be fetched electronically, and you can upload your images (opens in a new tab) in advance; doing so is not a review and does not create an appointment. You stay free to return to your own surgeon. The second opinion page explains the process.

For a full knee replacement, Dr. Morton goes in through the subvastus approach on nearly every patient. The quadriceps tendon is left alone; he works underneath the muscle instead. Very muscular or tight knees, a pronounced deformity, scarring from earlier operations and most revisions can need another approach. He does not use a tourniquet on any primary knee.

Implant position is tailored to your own alignment and ligament tension, inside published safe-zone limits, with the caveat that long-term durability data for that personalized method is still coming in. He fixes the parts without cement when your bone is strong on X-ray and in the operating room, and with cement, the longest-proven option, when it is not; consent covers both. If your work involves kneeling, ladders or long hours standing, say so at the first visit, because it shapes the recovery plan and when you can go back. More on the knee replacement hub and in the fixation section of the philosophy page.

The direct anterior approach is Dr. Morton’s routine for hips. He comes in from the front of the joint and opens only the capsule; muscles stay attached to bone. Most patients therefore leave without hip precautions, which helps with ordinary things like sitting at a desk or getting into a car. When a previous hip operation, retained hardware, a significant deformity, a large overhanging skin fold or a history of slow wound healing makes another approach safer, he will explain why.

For a first-time anterior hip, a bikini-line incision may be possible when your anatomy allows; if he needs more exposure, he extends it to a standard anterior incision instead of compromising implant position. Robotic guidance is used on essentially every hip to plan cup angle, stem size, leg length and offset. Leg length is confirmed with X-rays in surgery, though robotics cannot guarantee equal legs. See direct anterior hip replacement.

When arthritis is limited to just one part of the knee, a partial knee can be a strong option, whatever your activity level. It replaces only the worn compartment and keeps the ACL. It may suit you if the arthritis is confined to that compartment, the ACL is intact, the knee extends well, any deformity is mild and correctable, and therapy, medication and injections no longer help enough. It is not the right choice when two or three compartments are worn, the ACL is torn or missing, you have inflammatory arthritis such as rheumatoid arthritis, or deformity is severe.

Dr. Morton performs medial, lateral, patellofemoral and bicompartmental partial knees, planned in 3D and done with robotic assistance through a smaller incision, without a tourniquet. Partials are revised somewhat more often over a lifetime; converting to a total later is generally simpler than revising a failed total, yet it is still a revision. Age doesn’t settle it; an exam and standing X-rays at Kunia do. See partial knee replacement.

Every robotic case starts with Dr. Morton’s own 3D plan for implant size and position. In surgery the robot gives real-time feedback on alignment and balance and holds the work to that plan, but it does not cut on its own or make a single decision; Dr. Morton performs each step. On O‘ahu the system is matched to the case and the venue, and at Queen’s it is ROSA®, which plans from regular X-rays without a CT scan.

Two practical points. Robotic assistance is billed as standard joint replacement, without a technology fee or separate patient charge, and it does not change Medicare coverage. And robotic planning is part of every partial knee he performs. Dr. Morton is certified on ROSA, Mako, CORI and VELYS and in 2022 performed Hawai‘i’s first robotic-assisted total hip replacement. Read about his training and background and the robotic planning section of his philosophy page.

Infection in a replaced joint is treated according to timing. An early infection can sometimes be cleared while keeping the implant, through debridement, antibiotics and implant retention with a new plastic liner (DAIR). A chronic infection usually calls for a two-stage revision, with a single-stage exchange for selected cases. Those decisions are made with infectious-disease specialists and the hospital resources at Queen’s, so do not wait on a joint you think may be infected.

Replacements done somewhere else, including on the mainland or overseas, are a regular part of Dr. Morton’s Revision Hip & Knee Clinic. The workup identifies the implant’s model, size and recall status, compares new and old X-rays, checks ESR and CRP, cultures joint fluid when needed, and adds metal-artifact-reduction MRI or CT if a question remains. Revisions are planned at a hospital, usually with a short inpatient stay. See infected knee replacement.

Head down H-2, then west on H-1, and you reach the Kunia Shopping Center, where the clinic has free parking right outside. Consultations, imaging, injections and follow-ups all happen there, and Wiki Wiki Orthopedics, a walk-in orthopedic urgent care with X-ray on site, is in the same center for new injuries (call ahead for that day’s hours). If you happen to work in town, the Ala Moana clinic is an alternative.

Some appointments are with Justin Grandalen, PA-C, who works alongside Dr. Morton, and you can ask to see Dr. Morton at any visit. The surgical venue is decided with you based on the procedure, your health and your insurance; complex, revision and higher-medical-risk cases are generally scheduled at The Queen’s Medical Center. Schedule online or call (808) 439-6201. Patients from neighboring Wahiawā and the North Shore use the same clinic.

Mililani’s parks give you places for the short, frequent walks that early recovery runs on. Most people use a walker for about the first couple of weeks and then move to a cane as balance allows. Physical therapy starts on the first or second day home, with any licensed therapist near you or in-house at the Kunia clinic, and the office sends Dr. Morton’s written protocols to whoever you choose.

Your first follow-up is around one week after surgery. After that, some check-ins can happen by Doximity video: the office texts a link to your iPhone or Android phone, which saves a drive down H-2. If you go home the same day, you need someone with you for at least the first night; the travel guide’s support person section explains what that person does. Most patients take aspirin for several weeks after surgery, about the first month for a knee, to lower clot risk.