Who to refer
Dr. Paul Morton is a board-certified, fellowship-trained hip and knee surgeon who sees patients at Pacific Bone & Joint in Honolulu, West O‘ahu, Hilo and Kona, and he performs every surgery himself. Not every referral ends in an operation: the first visit covers the full range of options — physical therapy, injections or biologics, a repair, or joint replacement — and a patient who doesn't need surgery leaves with a plan for what to do instead. Second opinions on a surgical recommendation are welcome too. The patients who benefit most from a referral:
- Hip and knee arthritis — pain that limits walking, sleep or work (arthritis care)
- Arthritis that hasn't responded to non-operative care — therapy, injections, bracing or activity changes tried without lasting relief
- Candidates for robotic hip or knee replacement — robotic anterior hip and robotic knee replacement, same-day outpatient surgery when the patient qualifies
- Partial knee replacement — arthritis confined to a single compartment with an intact ACL (partial knee)
- Painful, failed or infected joint replacements — worked up in the revision clinic, including patients whose original surgeon has retired or who moved away
- ACL, meniscus and cartilage injuries — ACL, meniscus and cartilage restoration; refer a complete ACL tear early, because BEAR® implant repair has to be done within 50 days of injury
- SI joint dysfunction — one-sided low back or buttock pain that spine imaging doesn't explain, including after a lumbar fusion (SI joint fusion)
- Hip fractures and acute trauma — through the emergency department and the on-call team rather than an office referral; see urgent cases below
What to send with a referral
A complete packet lets the office verify coverage and schedule your patient without a second round of calls. Send what you have; a missing item shouldn't hold up the referral. Imaging done in Hawai‘i can usually be retrieved electronically, and standing X-rays can be taken in the clinic at the first visit.
- Demographics and insurance — name, date of birth, phone number and a copy of the insurance card
- The referral or authorization, where the plan requires one — most managed-care, HMO and Medicaid/Quest plans do, while PPO plans and traditional Medicare generally allow self-referral; Kaiser members come through Added Choice with a referral, and veterans through a VA Community Care referral (plans accepted)
- Recent notes — the question you want answered, relevant history, the current medication list including any blood thinner, and what has already been tried
- Imaging reports, and where the images are — the facility holding them; standing knee X-rays or an AP pelvis and hip films if available; any MRI report
- Prior operative reports — for any earlier surgery on the joint, plus implant records (the implant card or stickers) for a painful or failed replacement
How to send it
Fax referrals and records to (808) 439-6202. Call (808) 439-6201, Monday to Friday, 8:00 am – 4:30 pm Hawai‘i Standard Time, to talk through a patient, ask whether a plan needs a referral, or check on a referral you've sent. Email Contact@pacificboneandjoint.com is for general, non-PHI questions only; please send patient information by fax, not email. The office replies to inquiries within one business day.
One office line serves all four clinics, so note on the referral which one suits your patient: Honolulu (1441 Kapiolani Blvd, Suite 2020), West O‘ahu (94-673 Kupuohi St, Suite C205, Waipahu), Hilo (75 Puuhonu Pl, Suite 204) or Kona (75-184 Hualalai Rd, Suite 205). Your patient can also schedule online through Klara, the practice's secure booking service.
- Step 1
Fax the referral
Referral, recent notes, imaging reports and any operative reports to (808) 439-6202.
- Step 2
Coverage checked
The office verifies benefits and any referral or prior-authorization requirement.
- Step 3
Patient scheduled
At the clinic that suits your patient, or by telehealth when an in-person visit isn't practical.
- Step 4
Questions answered
Call (808) 439-6201 about the visit or the plan; the office replies to inquiries within one business day.
After the visit
After your patient is seen, call (808) 439-6201 to ask about the diagnosis, the options discussed and the plan, or to check on surgery scheduling. A patient who doesn't need surgery leaves with a plan for what to do instead. The office replies to inquiries within one business day.
When surgery is planned, some of the preparation is best done with you: tightening diabetes control and working on smoking cessation in the weeks before surgery, and, after a fragility fracture, an osteoporosis plan coordinated with the patient's own physician.
Urgent cases and after hours
Urgent, but not an emergency. A suspected infection in a joint replacement, a wound problem in a recent post-operative patient, or an injury that needs to be seen quickly: call the office the same day at (808) 439-6201. Timing matters with a suspected joint-replacement infection, because an early or acute infection can sometimes be treated while keeping the implant, and that option narrows with time.
After hours, call Physicians Exchange at (808) 524-2575. The answering service reaches the on-call team when the office is closed.
Hip fractures and acute trauma go through the emergency department, not an office referral; Dr. Morton takes trauma call at The Queen's Medical Center and hospitals across O‘ahu (see hip fracture care). For a true emergency, call 911. Stable injuries that don't need an emergency room can walk in to Wiki Wiki Orthopedics in Kunia, which has X-ray on site; call to confirm that day's hours.
Neighbor-island and Pacific patients
Hawai‘i Island patients can be seen in person at the Hilo and Kona clinics. When an in-person first visit isn't practical, neighbor-island patients (Maui, Kauai, Moloka‘i, Lāna‘i) can have a telehealth first visit, with X-rays or MRI ordered at a facility near home so Dr. Morton can review current images on screen; patients in Guam and Saipan, American Samoa or the mainland start with a pre-travel video call that reviews their records and imaging to plan the trip. The hands-on exam still happens in person before any surgery.
When surgery is the answer, it happens in Hawai‘i: on O‘ahu, or for most robotic hip and knee replacements for Hawai‘i Island patients, on-island at Hilo Community Surgery Center. For off-island patients, pre-operative testing, surgery and early recovery are planned around a single trip. Afterward, follow-up runs by telehealth for patients in Hawai‘i (outside Hawai‘i, it is coordinated with the patient's local physician and therapist), Dr. Morton's written rehabilitation protocol goes to a physical therapist near home, and anything hands-on is coordinated with the patient's local physician. More on neighbor-island care and the fly-in patient program.
For physical therapists
Dr. Morton's written rehabilitation protocols are shared with a therapist near the patient's home as a routine part of care, so you and the surgical team work from the same milestone-based plan. Call (808) 439-6201 and the office sends the current protocol for the patient's procedure, by email or fax. Protocols are available for:
- Direct anterior hip replacement
- Robotic knee replacement
- Partial knee replacement
- ACL surgery
- Meniscus surgery
- Cartilage restoration
The protocols are guides, not prescriptions, and Dr. Morton adjusts progression to the specific surgery and the patient's milestones; more on how they work under rehabilitation protocols. If something you're seeing doesn't fit the protocol, a phone call is always welcome. The signs below are the same ones on the when-to-call card patients take home after joint replacement. For the emergency signs, call 911 or go to the nearest emergency room. For the others, call the office the same day at (808) 439-6201, or Physicians Exchange at (808) 524-2575 when the office is closed:
- Emergency, call 911: chest pain or sudden shortness of breath, coughing blood, fainting or loss of consciousness, or a leg that is cold, pale or numb
- Emergency, call 911: severe one-sided leg swelling with calf pain
- Emergency, call 911: sudden extreme hip pain with the leg in an unusual position, or sudden inability to bear weight after a fall
- Spreading redness around the incision, any opening of the incision edges, or drainage that increases or continues past the first few days
- Fever over 101°F (38.3°C), or chills
- New calf pain or swelling
- Pain that gets worse after it was improving
- No urination for 8 hours
- Unusual changes in leg color, temperature or sensation
Medically reviewed by Paul Norio Morton, MD, FAAOS, FAAHKS. Last reviewed: . This article is for education only and isn’t a substitute for an exam and personalized advice — schedule a consultation to discuss your situation.