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

Hearing “you need a total knee” or “this replacement has to come out” is a good moment to pause. Sometimes the answer is that your surgeon is right and you can go ahead with confidence. Sometimes it is a partial knee instead of a total, a different reason for the pain, or a smaller step to try first. With revisions the stakes rise, because operating without a proven cause can leave the original problem in place.

Dr. Morton studies your films and scans personally, reads prior operative notes, examines the joint, and puts his conclusions and options in writing, typically within one to two weeks. Facilities in Hawai‘i can usually send images to the office electronically, and if you hold copies you may also upload your images (opens in a new tab) beforehand, which neither reviews them nor sets up a visit. Whether you then have surgery here or with your original surgeon is your call. See the second opinion page.

If a total knee does turn out to be the answer, here is how Dr. Morton approaches it. He uses the subvastus approach on nearly every total knee, sliding beneath the quadriceps instead of dividing its tendon, and he moves to another approach for very muscular or tight knees, significant deformity, a knee scarred by past surgery, and most revisions. No tourniquet is used on a first-time knee replacement.

The components are positioned to respect your natural alignment and ligament balance, within published safe-zone limits, and long-term durability data for this personalized method is still accumulating. Fixation is decided by bone quality: cementless parts where bone looks strong on X-ray and proves strong in surgery, cemented parts where it is weaker. Cement has the longest track record, and your consent covers both. Replaced knees commonly last 20 years or more, which is part of why getting the first operation right matters. The knee replacement hub covers each step.

Hips are done through the direct anterior approach as Dr. Morton’s standard. Only the joint capsule is opened, the muscles are not cut or detached, and most people go home without hip precautions. He recommends a different approach when it is the safer path, for example after earlier surgery on that hip, with retained plates or screws, with significant deformity, under a large overhanging skin fold, or after wound-healing problems; a revision hip may go back through the old incision. A bikini-line incision is an option when anatomy allows.

Most of his hips use a titanium cup, a cross-linked polyethylene liner and, usually, a ceramic head, fixed without cement when bone allows. A dual-mobility bearing is reserved for patients at higher risk of dislocation, and the choice is never driven by brand. Robotic planning sets the cup, stem, leg length and offset, and leg length is checked with X-rays in the operating room. See direct anterior hip replacement and the implant selection section of the philosophy page.

Told you need a total knee? Ask whether a partial was considered. A partial knee replaces only the worn compartment and keeps the ACL. It may fit when the arthritis is limited to one compartment, the ACL is intact, the knee still straightens well, deformity is mild and correctable, and nonsurgical care (therapy, medication, injections) has stopped working. If two or three compartments are worn, the ACL is torn or gone, the arthritis is inflammatory (rheumatoid arthritis, for example), or the deformity is severe, the total stays the right call.

Dr. Morton performs all four kinds of partial (medial, lateral, patellofemoral and bicompartmental), each planned in 3D and done robotically through a smaller incision without a tourniquet. The caveat: partials are revised a little more often over a lifetime, and converting one to a total later, though usually simpler than revising a failed total, is still a revision. Your age won’t decide it; your exam and standing X-rays will. See the partial vs total comparison.

Robotic assistance is how Dr. Morton carries out his plan, and it does not change how your insurance treats the operation. It is billed as standard joint replacement, with no technology fee and no separate patient charge. Medicare coverage stays the same, and for veterans using VA Community Care, the robot does not alter how a replacement is approved.

In practice, he builds a 3D plan of your joint first. During surgery the robot keeps the instruments on that plan and reports alignment and balance in real time; it never cuts by itself and makes no decisions, and he performs every step. Which robot is used on O‘ahu depends on the case and the hospital; at Queen’s it is ROSA®, which needs no CT because it plans from ordinary X-rays. His certifications span ROSA, Mako, CORI and VELYS, and in 2022 he did the first robotic-assisted total hip replacement in Hawai‘i. Learn more about ROSA and his fellowship training.

Dr. Morton’s Revision Hip & Knee Clinic works on one principle: no revision without a reason. A painful or unsteady replacement goes through a set workup first. New X-rays are compared with earlier ones, blood is tested for ESR and CRP, joint fluid is drawn and cultured if infection is possible, metal-artifact-reduction MRI or CT is added when needed, and the implant’s model, size and recall status are confirmed. The answer is not always surgery: pain referred from the spine or SI joint, or an irritated tendon, can feel like a failing implant.

When revision is the answer, it is planned around what failed: loosening, infection, instability, wear and bone loss, fracture near the implant, a metal reaction, stiffness, or a malpositioned part. Bone is rebuilt with porous augments, cones or sleeves and revision stems; instability is addressed with bearing and implant choices. Revisions are planned at a hospital, most often The Queen’s Medical Center, usually with a short inpatient stay.

From Wahiawā, the Kunia clinic is the nearest office, reached by heading down H-2. Its home is the Kunia Shopping Center, where parking is free, and visits there cover consultations, imaging, injections and follow-up care. Some later follow-ups can happen by video on Doximity: the office texts a link, you open it on an iPhone or Android phone, and the visit runs while you are at home. An in-person exam always happens before any surgery.

Veterans begin by asking their VA provider to refer them through Community Care; once the VA approves it, the office arranges the visit and paperwork. For TRICARE, the office checks whether your plan needs a referral first. Some visits are with Justin Grandalen, PA-C, who works with Dr. Morton; you can always ask for Dr. Morton. Surgery is scheduled where it fits your procedure, health and insurance. Call (808) 439-6201; most new patients are seen within one to two weeks. Neighbors in Mililani and on the North Shore use the same clinic.

Most patients walk on the day of surgery, usually with a front-wheeled walker. That walker is often arranged through the hospital or your insurance, so ask before buying one. Expect to need it for about the first couple of weeks before trading it for a cane as your balance comes back. Therapy begins within the first day or two at home, either in your living room or at a clinic. Any licensed therapist near Wahiawā can do it; if you do not have one, the office will suggest a few and send them Dr. Morton’s written protocols.

Plan a ride for your first follow-up, around one week after surgery. Later wound checks and progress reviews can often be done by video, and from then on, a yearly X-ray watches the implant for life. For clot prevention, aspirin for several weeks is typical, roughly a month after a knee; higher-risk patients may get a prescription blood thinner instead. The travel guide’s mobility aids section has more on walkers and canes.