Hip & Knee Replacement for Patients on the Wai‘anae Coast, Hawai‘i

A revision is a bigger undertaking than a first replacement, so before you agree to one, it pays to hear from a surgeon who does a great deal of them. Revision work referred by other surgeons makes up roughly half of Dr. Morton’s practice, and a first replacement you feel unsure about gets the same careful look. He studies the films and scans himself instead of trusting a summary, examines the joint, and gives you a written opinion with the choices laid out, typically within one to two weeks. Whether you stay with your current surgeon is up to you.

To get the most from the drive, gather images, operative notes and the recommendation you received before the visit, and upload your images (opens in a new tab) so they are waiting; the upload only stores them and is neither a review nor a booking. If getting down Farrington Highway is not realistic at first, the discussion can open over video while you are in Hawai‘i, but an in-person exam always comes before any surgery. See the second opinion page.

One visit at Kunia can cover a lot of ground for a worn knee: the exam, standing X-rays, and a frank talk about which operation fits. Dr. Morton’s total knees almost always go in beneath the quadriceps, the subvastus route, so its tendon is left whole. He chooses differently for knees that are especially muscular or tight, badly bent out of line, scarred from an earlier operation, or being revised. Primary knees are done tourniquet-free, and the cut is commonly four to six inches long.

The components are angled to respect the way your leg naturally lines up and how your ligaments pull, staying inside published safe zones; how well this tailored method holds up over decades is still being studied. Cementless fixation is used when bone is firm and cement when it is soft, cement having the longer history, and your consent form covers either. Details are on the knee replacement hub and the tourniquet-free knee page.

If the hip has been operated on before, perhaps a fracture repair with screws or a plate still in place, bring those records to the first visit. Dr. Morton’s usual hip goes through the front, the direct anterior approach, opening only the joint capsule while the muscles stay attached, and most people need no hip precautions afterward. Earlier surgery and leftover hardware are among the reasons another approach can be safer; a marked deformity, a heavy skin fold at the front of the hip or a history of slow-healing wounds are others. He will say if any applies.

Where your anatomy allows, the incision can follow the bikini line (see bikini-line incision). Robotic guidance helps plan the socket, stem, leg length and offset on essentially every hip. Most hips get a titanium socket shell with a cross-linked plastic lining and, more often than not, a ceramic ball, fixed without cement when the bone permits; for hips more prone to dislocating, a dual-mobility bearing is an option. See the hip replacement overview.

One Kunia appointment can usually answer the partial-or-total question. Standing X-rays are taken on site and Dr. Morton examines the knee; MRI comes in only if a particular question is still unanswered. A partial knee swaps out a single worn compartment and leaves your ACL in place. It fits arthritis limited to that one area, a healthy ACL, a knee that still gets straight, a minor deformity that corrects, and pain that has not eased with therapy, medicines and injections.

A total is the better operation for wear spread over more than one compartment, an ACL that is torn or gone, inflammatory arthritis such as rheumatoid, or a severe deformity. Medial, lateral, kneecap (patellofemoral) and bicompartmental partials are all part of his practice, planned in 3D and done with robotic help through a shorter incision, without a tourniquet. The catch: across a lifetime a partial is revised a bit more often, and changing it to a total, while usually easier than redoing a failed total, is still revision surgery. Age is not the decider. See partial vs total knee.

The robot is a tool Dr. Morton guides; it is not the surgeon. He prepares a 3D plan for your joint in advance. In the operating room the robot helps him carry out that plan, measuring alignment and balance as he works, yet it cannot cut independently and decides nothing; each step is his. Which platform is used on O‘ahu depends on your case and hospital. Queen’s uses ROSA®, planned from plain X-rays, so no CT appointment gets added to your drive.

Robotic assistance adds neither a technology fee nor a separate charge to you, since it is billed as standard joint replacement, and Medicare coverage is unaffected. Dr. Morton is certified on four platforms (ROSA, Mako, CORI and VELYS) and in 2022 performed the first robotic-assisted total hip replacement in Hawai‘i. Patients have nicknamed him “The Robot Doc.” See the robotic planning section of his philosophy page.

No revision should be scheduled until its cause is proven. Dr. Morton’s Revision Hip & Knee Clinic follows a fixed sequence for a painful or failing joint: today’s X-rays laid against older ones, ESR and CRP blood work, a joint aspiration with culture when infection is possible, metal-artifact-reduction scans (MRI or CT) when a question remains, and a check of exactly which implant is inside and whether it has been recalled. Sometimes the pain comes from somewhere else, such as the spine or an irritated tendon, and the solution lies outside the operating room.

When surgery is needed, the repair is matched to the problem: a loose or worn component, infection, an unstable or stiff joint, a break in the bone next to the implant, a reaction to metal debris, or parts placed out of position. Infection is handled with timing in mind, missing bone is rebuilt, and instability is corrected with implant and bearing choices. Expect the operation at a hospital, mostly Queen’s, and usually a short inpatient stay. See revision knee replacement.

Every trip off the coast starts on Farrington Highway, so the goal is to make each one count. The Kunia clinic sits in the Kunia Shopping Center, parking is free, and H-1 and H-2 are close by. A consultation and imaging can be done in one sitting there, and it also handles injections, the visit before surgery and post-operative checks. Justin Grandalen, PA-C, works with Dr. Morton and handles some visits and questions in between; ask whenever you would like Dr. Morton himself. For a new injury, the practice runs a walk-in orthopedic urgent care, Wiki Wiki Orthopedics, in the same center, with X-ray on hand; call ahead to check that day’s hours.

Surgery takes place at Queen’s in Honolulu, where complex and revision cases usually go, or at Castle in Kailua; the choice weighs the operation, your health and your coverage. Plans accepted include HMSA, Medicare, Medicaid/Quest and AlohaCare, among others. Quest and other managed-care plans may require a referral from your primary care doctor, which the office confirms ahead of time so no drive is wasted. Phone (808) 439-6201 or book online.

Physical therapy need not add highway miles. Sessions get going within a day or two of coming home, at your house or a clinic, with whichever licensed physical therapist is easiest to reach from Nānākuli, Mā‘ili, Wai‘anae or Mākaha. Ask the office for names nearby; your therapist receives Dr. Morton’s written rehabilitation protocols directly. Kunia has in-house therapists too.

Some check-ins can happen over video while you are in Hawai‘i, so the team can see your incision and how you are moving without you making the drive. The first follow-up is about one week after surgery. Plan on a walker from surgery day through roughly the first couple of weeks, then a cane. You can drive again once you are off narcotic pain pills and can stop hard without hesitating, on average two to six weeks. Most patients take aspirin for several weeks to help prevent clots, exactly as prescribed. After that, a yearly X-ray keeps watch on the implant.