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

A long drive is a poor reason to accept advice you are unsure about. If you have been told you need a hip or knee replacement, or that a replaced joint has to be redone, a second opinion lets someone independent check the reasoning before you commit. Dr. Morton looks at the images himself, not only the radiologist’s summary, goes through any prior surgical records, examines you, and gives you his impression in writing, typically within one to two weeks.

To make one trip do the work of several, gather your X-ray, MRI or CT images beforehand; studies done in Hawai‘i can usually be retrieved electronically before you arrive. If getting to town is the hurdle, the first conversation can be a video call from your kitchen table, with a hands-on exam before any surgery is booked. You will not be pressed to change surgeons, and many patients carry the written impression back to the doctor who first advised them. The second opinion page explains what helps most.

Nearly every total knee Dr. Morton performs uses the subvastus, or quad-sparing, approach, in which he works under the quadriceps rather than cutting into its tendon. Exceptions include very muscular or tight knees, significant deformity, scarring from earlier surgery and most revisions. No primary knee gets a tourniquet. The implant is aligned to your own leg and ligament balance within published safe-zone limits.

Fixation is matched to your bone: cementless when X-rays and the operating room show strong bone, cemented when it is weaker, with cemented implants carrying the longest track record. If your days involve kneeling in a garden bed, climbing ladders or carrying loads, say so at the first visit. Those demands shape how long the return to that work takes. The knee replacement hub and the cementless knee page explain more.

Dr. Morton’s usual hip operation is the direct anterior approach, in which the capsule around the joint is the only layer opened and the muscles keep their attachments, so most people follow no hip precautions at home. Prior surgery on that hip, retained hardware, significant deformity, a large overhanging skin fold or poor wound healing in the past can make another route safer, and he will say so. A bikini-line incision is possible when your anatomy allows.

Implants are usually a titanium cup holding a cross-linked polyethylene liner and, in most cases, a ceramic head, placed without cement when bone quality allows. A dual-mobility bearing is saved for patients at higher risk of dislocation. The robotic plan fixes where the cup sits, the stem size, and the leg’s length and offset, and an X-ray in the operating room checks length again. See the hip replacement hub and the implant selection notes.

Resurfacing just one compartment and keeping the ACL, a partial knee is an option when the arthritis has stayed in that one compartment, the ACL still does its job, the knee can straighten well, any angular deformity is mild and correctable, and therapy, medicine and injections have run their course. If wear has reached two or three compartments, the ACL is damaged or missing, the arthritis is inflammatory, such as rheumatoid, or the deformity is severe, a total knee fits better.

Helpfully for a Waimānalo patient, candidacy rests on an exam and standing X-rays, not on age, and the Ala Moana clinic can take them during your consultation, so the answer need not wait for a second trip. Dr. Morton does all four designs: medial, lateral, patellofemoral and bicompartmental. The catch: partials are revised somewhat more often over a lifetime, and turning one into a total, though generally less involved than a redo of a failed total, still counts as a revision. See the partial vs total page.

A robot adds a planning step, not a line on your bill. Dr. Morton builds a 3D plan for your joint, and during surgery the robot follows it, reporting alignment and balance as he goes. The machine never makes a cut on its own and decides nothing; he performs the operation. How it is billed, including under Medicare, is covered in the questions below.

Platforms on O‘ahu are matched to each case and hospital. At Queen’s the system is ROSA®, which works from ordinary X-rays, so there is no extra CT appointment and no extra drive to town for one. Dr. Morton holds certification on four platforms, ROSA, Mako, CORI and VELYS, and in 2022 performed the state’s first total hip replacement with robotic assistance; his training is summarized separately. For a hip, standing and sitting spine X-rays can personalize the cup angle in the plan. Read more about ROSA and the robotic planning section of his philosophy page.

Joint replacements can wear or loosen quietly, and an X-ray may show the change before you feel it. That is why Dr. Morton recommends an X-ray every year for life through implant surveillance, whoever performed your surgery. When a replaced hip or knee does start to hurt, his Revision Hip & Knee Clinic finds the cause before any operation is discussed: new X-rays set against your older films, ESR and CRP blood tests, joint fluid tested for infection when it is a possibility, metal-artifact-reduction MRI or CT when needed, and identification of the exact implant and its recall status.

Findings range from loosening, infection and instability to worn bearings with bone loss, fractures next to the implant, metal-debris reactions, stiffness and poorly positioned parts. Lost bone is rebuilt using porous metal augments, cones or sleeves, plus revision stems. Revision surgery takes place in a hospital, Queen’s for most and Castle for some, and generally involves a short stay.

Consultations happen in town at the Ala Moana clinic, across from Ala Moana Center, with parking inside the building. Bring identification, your insurance card, a list of medicines and any earlier X-rays, MRI or operative reports, and new standing X-rays can be taken and reviewed while you are there. Later check-ins often move to video on Doximity; a text from the office carries the link, and you join from home on iPhone or Android.

Where surgery happens is decided with you, weighing which operation you need, your health and your insurance. Adventist Health Castle in Kailua is the closest venue to Waimānalo; same-day surgery there is possible for qualified patients, with an overnight stay when your health calls for it. The Queen’s Medical Center is where complex work, revisions and patients whose health carries more risk are usually scheduled. Phone the office at (808) 439-6201 between 8:00 am and 4:30 pm on weekdays; new patients typically get an appointment within one to two weeks.

Before the operation, make a plan for any steps into your house and decide who will stay with you for at least the first night if you go home the same day. Most people are up and walking on the day of surgery. The first follow-up comes around one week later, and between visits wound checks by camera and therapy adjustments can happen by video, which saves trips over the Pali or around Makapu‘u.

Work is the question with the widest range. Desk jobs often resume two to four weeks after a hip and around six weeks after a knee. Farm work, construction and other jobs that mean standing, kneeling, lifting or climbing all day take longer, and Dr. Morton clears each one individually. Clot prevention is usually aspirin for several weeks; take it precisely as written. The prehab guide helps you build strength beforehand, and the knee recovery guide maps the months after.