Hip & Knee Replacement for Patients on O‘ahu’s North Shore

Any trip to town takes planning, so be confident before committing to an operation. A second opinion is especially useful in three situations: a total knee has been recommended but you suspect only one part of the knee is worn; a hip operation is on the table and you want the reasoning tested; or a joint replaced years ago has started to slip, give way or ache. Dr. Morton looks at the films himself, examines the joint, and follows up in writing with what he sees and the paths open to you, usually within one to two weeks. Staying with your own surgeon remains your choice.

Before setting out, upload your images (opens in a new tab) so the films are waiting when you arrive; the portal simply holds them and is neither a review nor a booking. While you are in Hawai‘i, a first conversation can take place by telehealth if the trip is not practical yet, but a hands-on exam always comes before surgery. A checklist is on the second opinion page.

With a new knee, even the ocean waits until the incision has healed and you are cleared, typically at six weeks; surfing comes later. In surgery, Dr. Morton slips under the thigh muscle on nearly all total knees, the subvastus approach, rather than splitting the quadriceps tendon. He departs from it for knees that are very tight or muscular, notably deformed, scarred from earlier operations, or being revised. A first-time knee never uses a tourniquet, and the incision usually spans four to six inches.

The implant is fitted to your own leg alignment and the balance of your ligaments, inside the safe zones that published research describes, and the long-run record of this personalized technique is still accruing. Bone that looks solid on X-ray and proves solid in surgery gets cementless parts; softer bone gets cement, the longest-proven option, and the consent form covers both. A knee implant commonly lasts 20 years or more. See sports after knee replacement.

If you spend time in board shorts or a swimsuit, scar placement may be on your mind. Dr. Morton replaces hips from the front as a rule, the direct anterior approach: he opens the capsule of the joint, leaves the muscles attached to bone, and usually no hip precautions are needed. On a first anterior hip, the incision can follow the bikini line when your anatomy allows, which suits an active, ocean-going life. If he needs more room once surgery is underway, he lengthens it into a standard anterior incision instead of settling for a less accurate implant position.

Sometimes another approach is the safer one, as with an earlier hip operation, hardware still in the bone, marked deformity, a heavy overhanging skin fold, or a history of slow wound healing; he will explain if so. On essentially every hip, robotic planning sets where the cup sits, the stem size, leg length and offset. The usual bearing is a ceramic head moving in a cross-linked polyethylene liner inside a titanium cup, held without cement if bone allows; brand loyalty never enters into it. See direct anterior hip replacement.

Some knees wear out on one side only, and then a partial knee may be enough. The checklist: arthritis limited to one compartment, an ACL that still works, a knee that straightens well, a small deformity that corrects, and pain that has outlasted therapy, medication and injections. A partial swaps out only the worn compartment and spares the ACL; it is mapped in 3D and placed with robotic guidance through a shorter, tourniquet-free incision. Medial, lateral, patellofemoral and bicompartmental versions are all part of Dr. Morton’s practice.

Arthritis across two or three compartments, a torn or missing ACL, an inflammatory arthritis like rheumatoid, or severe deformity points toward a total knee. There is a trade-off to weigh: over a lifetime, partials need revising somewhat more often, and while switching one to a total is generally less involved than redoing a failed total, it is still revision surgery. Age by itself is not the test. Standing X-rays and an exam, both available at your Kunia visit, settle candidacy. Read the partial vs total section of Dr. Morton’s philosophy page.

Wherever it is used, the robot serves the same purpose: it assists Dr. Morton and never stands in for him. Before the operation he builds a 3D plan for your joint; during it, the robot helps him follow that plan and reports alignment and balance as he goes. It makes no cut on its own and no decision. The platform is chosen for your case and the hospital, and at Queen’s it is ROSA®, which plans from regular X-rays, no CT needed.

Certified on ROSA, Mako, CORI and VELYS, Dr. Morton performed Hawai‘i’s first robotic-assisted total hip replacement in 2022. To patients, he is “The Robot Doc.” The robot adds no technology fee or separate patient fee, because the operation is billed as a standard joint replacement, and Medicare coverage is unchanged. For hips, the plan includes leg length, which he also checks with X-rays during surgery, though robotics cannot promise legs of exactly equal length. See robotic hip replacement.

Two problems are especially worth a careful look: a replaced joint that is unstable, and one that still hurts. A hip that pops out, or a knee that buckles or feels sloppy, needs a diagnosis before a fix, and so does pain that has lingered past the end of a normal recovery. At Dr. Morton’s Revision Hip & Knee Clinic, the workup runs through fresh X-rays compared with old ones, inflammation markers in the blood (ESR, CRP), aspiration and culture of joint fluid if infection is a possibility, metal-artifact-reduction MRI or CT when the picture is still unclear, and confirmation of the exact implant and whether it has been recalled.

Instability is corrected at its source, often by revising a component and choosing a more stable bearing. A painful joint may turn out to be loose, infected, stiff, worn or malpositioned, or the pain may be coming from the spine or a tendon and need no operation. Revisions take place in a hospital, mostly Queen’s and sometimes Castle, usually with a short inpatient stay. Common hip causes are listed on the painful hip replacement page.

Pick the route that suits you. Inland through Wahiawā and down H-2, the Kunia clinic sits in the Kunia Shopping Center with free parking, and it takes care of consultations, X-rays, injections, pre-op visits and post-op care. Because the practice has no Windward clinic, patients planning surgery at Castle still have office visits at Kunia or Ala Moana, plus video visits. Some visits, and questions in between, may be handled by Justin Grandalen, PA-C, Dr. Morton’s physician assistant; a visit with Dr. Morton is always yours to request.

The surgical venue is a joint decision that weighs the procedure, your health and your coverage. Castle in Kailua provides hospital-based hip and knee replacement on the Windward side, and Queen’s takes complex cases, revisions and patients with higher medical risk. Same-day discharge is possible at both for patients who qualify, and an overnight stay is available when your health needs it. To get on the schedule, book online or call (808) 439-6201; a first visit is usually available within one to two weeks.

For most patients, walking starts on surgery day, walker in hand. Therapy follows within a day or two of getting home, where you live or at a clinic, and any licensed physical therapist handy to Hale‘iwa, Waialua, Kahuku or Lā‘ie can provide it. The office can recommend someone and will forward Dr. Morton’s written protocols; Kunia also has in-house therapists.

Not every check needs the drive. The first follow-up comes around one week after surgery, and some later ones can be done by video while you are in Hawai‘i, through a Doximity link the office texts to your iPhone or Android phone. Driving yourself along Kamehameha Highway waits until you are off narcotic pain medicine and can brake hard without hesitation, on average two to six weeks. Aspirin for several weeks is the usual protection against clots. For hips, the first year after hip replacement guide maps the months ahead, and a yearly X-ray keeps watch on the implant for life.