Traveling for joint replacement in Hawai‘i

For most patients flying in from another island, the answer is one trip for surgery. Everything else is arranged so you travel only when travel accomplishes something.

• Before the trip. Hawai‘i Island patients are seen at the Hilo clinic or the Kona clinic, and most of them have surgery in Hilo with no flight at all. There is no clinic on Maui, Kaua‘i, Moloka‘i or Lāna‘i, so patients there can start with a video visit, with X-rays or an MRI ordered at a facility near home.
• The surgical trip. Your in-person exam, final pre-operative testing, the operation and early recovery are grouped into the same stay, so one trip covers them all.
• After you go home. Follow-up continues at the Hilo or Kona clinic or by video while you are in Hawai‘i, and physical therapy continues with a therapist near you.

A complex case occasionally needs an extra visit; if yours does, you will know before you book anything. The hands-on exam always happens in person before surgery.

For O‘ahu patients, the logic is the same over shorter distances: consultations at the Ala Moana or Kunia clinic, surgery at The Queen’s Medical Center in Honolulu or Adventist Health Castle in Kailua, and follow-up planned so you cross the island no more than you need to. See the interisland travel page for the whole program.

Imaging is one of the first things the team needs, and it rarely requires a flight. X-rays, MRI or CT scans taken in Hawai‘i can usually be retrieved electronically by the office, so tell the team where yours were done. With no recent imaging, the office can order standing X-rays at a facility near home. An exam and weight-bearing X-rays come first; an MRI is ordered when a specific question remains.

If you already have images on a disc or in another portal, you can upload your images (opens in a new tab) through the practice’s MyMedicalImages portal so they are on hand before your visit. Send the images themselves, not only the radiologist’s report: Dr. Morton re-reads the films himself at your visit, and a report cannot show him the joint. Uploading is not a review, and it does not book an appointment.

If you want a second look at a surgical recommendation, or a replaced joint still hurts, ask for a second opinion. Dr. Morton reviews your imaging and records and gives you a written impression with your options, typically within one to two weeks. It is a specialist visit; most plans cover it as one, and the office checks your benefits when you schedule. There is no pressure to switch surgeons. Joints replaced elsewhere are evaluated through the Revision Hip & Knee Clinic.

Before any joint replacement, the team makes sure your body is ready for anesthesia and surgery. Medical clearance usually comes from your primary care provider, who knows your history. Dr. Morton and the anesthesia team then review your heart, lungs, medications and any past experience with anesthesia.

Depending on your health, testing may include blood work and an EKG. Not everyone needs the same tests, so the office tells you which ones apply to you and can schedule them. If you live on a neighbor island or far from Honolulu, ask whether the tests can be done near home; that way the results travel instead of you. Patients having Mako robotic surgery in Hilo also have a CT scan of the joint, from which the 3D surgical plan is built.

For fly-in patients, the final round of testing is usually folded into the surgical trip, alongside the in-person exam, so it does not need a separate flight. Put those dates into your itinerary as soon as the office gives them to you. If a result needs attention, it is worked through with you and your own doctor before surgery goes ahead. The consultation page explains what to bring to your first visit.

Some health factors can be improved before surgery, and the team raises them only when they apply to you. For patients who live far from Honolulu, most of this work happens at home with your own doctor and dentist, which is one less reason to travel.

• Diabetes. If you have diabetes, your A1c is reviewed with you and your primary care physician, and a target is set before surgery.
• Smoking and vaping. Nicotine from any source, vaping included, interferes with bone and wound healing, and quitting well before surgery improves it. The Hawai‘i Tobacco Quitline at 1-800-QUIT-NOW offers telephone and online help. See how smoking affects surgery.
• Weight. There is no universal BMI rule. Each patient is evaluated individually, and for some the plan includes a period of preparation before surgery. See BMI and joint replacement.
• Dental health. See your dentist before surgery and take care of known problems first. After a joint replacement, elective dental work waits about three months. See antibiotics and dental work.

Before surgery, the team gives you written instructions on which medicines to keep taking, which to pause and when. Blood thinners and some supplements are the usual examples, because they can affect bleeding. If another doctor prescribes your blood thinner, make sure both offices know the plan, and do not stop or restart anything on your own.

After surgery, you go home with a clot-prevention plan. Most patients take aspirin for several weeks; patients at higher risk may be prescribed a different blood thinner. Take the whole course as written, even when you feel well. Pain relief combines several medicines on a schedule, with any opioid kept for breakthrough pain and stopped first. The medication guide and blood clot prevention page explain each part.

Travel adds a few practical points:

• Keep your medicines and a current list of them in a bag that stays with you, not in checked luggage.
• Bring enough of everything for the whole trip, with some extra in case your return date moves.
• Do not change doses, skip doses or add anything because you are flying. If the flight raises a question about your medicines, ask the team before you travel.

Most traveling patients stay in a hotel or condo near the clinic for the surgical trip, and many book it themselves. What matters is how the place works for someone walking with a walker:

• An elevator or ground-floor access, not stairs.
• Short, easy walking routes, since frequent short walks are part of recovery.
• Room for your companion to stay with you.
• An ADA-compliant room and bathroom. Confirm this with the property directly before you book.

The Ala Moana–Waikīkī corridor is a common choice. The Honolulu clinic sits across from Ala Moana Center, with parking in the building, a flat neighborhood that suits early walks, and The Queen’s Medical Center minutes away. Once your surgery is scheduled, the care coordinator can share recovery-friendly suggestions. The practice is not affiliated with any property, so the choice stays yours.

Ask the office whether your health plan offers interisland travel assistance; some Hawai‘i plans help with airfare and lodging for medically necessary off-island care. If you would rather hand the planning to someone else, the Elite Recovery level of the optional Rapid Recovery Concierge can arrange your travel and lodging into one itinerary; the travel costs themselves are not included.

Plan every ride before you leave home. On O‘ahu you need to get from the airport to your lodging, then to each appointment: the pre-operative visit and testing, surgery at Queen’s or Castle, and follow-up. Line up a ride for each one.

You will not drive yourself after surgery. Driving waits until you are off narcotic pain medicine, can brake hard without hesitating, and Dr. Morton confirms it is safe, so plan the surgical trip as though you will not be behind the wheel. Your companion, a family member or a ride arranged in advance can cover the trips, and someone must take you back to your lodging when you are discharged. See driving after hip or knee replacement.

Request airline wheelchair or cart assistance when you book your flights, not on the day; there is no reason to tire a new joint on a long terminal walk. Someone should also meet you at your home airport.

O‘ahu patients crossing the island still need a driver for surgery, the ride home and the first follow-up. Windward residents can have surgery at Castle in Kailua without crossing the Ko‘olau, and patients from the Wai‘anae Coast, Central O‘ahu or the North Shore often find the West O‘ahu clinic in Kunia, near the H-1 and H-2, the easier stop.

Bring someone with you. A companion for the trip and the first days after surgery is part of what makes recovery away from home safe, and same-day discharge requires someone with you through at least the first night. Your companion is not expected to give medical care or change dressings. Their job is to be there:

• Ride with you to surgery, back to your lodging and to your first follow-up visit.
• Keep your medicines on schedule, with meals and water.
• Walk with you for short, frequent walks while you are awake, and help with ice and elevation afterward.
• Watch for problems and call the office, or 911 in an emergency.

If your surgery is at Hilo Community Surgery Center, your companion must take you home afterward and remain with you, overnight included, for at least the first 24 to 72 hours. For fly-in patients, the most useful companion is someone who can stay for the whole trip and fly home with you. If no one can come, say so early. The team can talk through other recovery settings, and the Elite Recovery level of the concierge program is built with patients who have no help at home in mind.

Most patients walk on the day of surgery, using a walker at first. A front-wheeled walker is what most people use for about the first couple of weeks, followed by a cane as balance and strength allow. Your therapist and the team tell you when to make each change.

Ask before you buy anything. Walkers and crutches are often arranged through the hospital, the surgery center or your insurance, and buying your own in advance can leave you with two. Travelers need a walker both during the surgical stay and at home. Ask the office how equipment is being arranged for your surgery, and ask the airline when you book how a walker travels with you.

Small things help on a trip: a pouch or tray clipped to the walker so a phone and water bottle ride along while both hands stay on the frame, a plan for any steps at your lodging, and a home with clear walkways ready before you leave. Prehab covers practicing with a walker and planning for stairs, and the recovery products page lists equipment patients often ask about.

Your rehabilitation does not have to happen near Honolulu. You can work with any licensed physical therapist convenient to your home, on O‘ahu or on a neighbor island. The office can suggest therapists near you and sends Dr. Morton’s written rehabilitation protocols directly to the therapist you choose, so everyone works from the same plan.

The protocols are built on milestones rather than calendar dates: you move to the next phase when your knee straightens or your walking evens out, not because a set number of days has passed. Your therapist can call the office about progress, precautions or anything unexpected, and video check-ins keep Dr. Morton informed while you are in Hawai‘i.

Therapy starts on the first or second day after you leave the surgical facility. Fly-in patients usually begin near the clinic, then carry on with a therapist on their own island, so book that first home appointment before you leave for surgery. On O‘ahu, in-house therapy with PB&J Physical Therapy is available at the Honolulu and Kunia clinics. Prehab before surgery helps too: the exercises you learn beforehand are the ones you will use afterward.

If your joint replacement is on O‘ahu and you live on another island, plan on staying near the surgical facility for about 10 to 14 days. Treat that as a planning range, not a fixed date. The day you fly home is set by the surgical team: you stay through your first post-operative check, and you fly once they clear you to travel.

The first post-operative check, around one week after surgery, includes a wound check and a look at how your walking and early therapy are going. Fit-to-fly clearance follows when the team is satisfied. Both visits are planned before you arrive, so your itinerary has a shape from the start.

A few rules hold for everyone:

• You never fly home on the day of surgery.
• Book flights and lodging you can change, in case your recovery needs a little more time.
• Smaller procedures often need a shorter stay; the office tells you what to plan for yours.

Hawai‘i Island patients having same-day surgery in Hilo go home by car with their companion that day; the range above applies to them only when surgery is planned on O‘ahu. The interisland travel page shows a sample itinerary.

Fly only after the surgical team has cleared you. On the flight, a few habits help keep blood moving in your legs:

• Choose an aisle seat so you can stand and stretch.
• Get up and walk when you can.
• Drink water through the trip.
• Do ankle pumps in your seat, pointing your toes up and down again and again.
• Follow your prescribed clot-prevention plan exactly. Do not take extra aspirin or another blood thinner just because you are flying.
• Use the wheelchair or cart assistance you requested when you booked.

Expect airport security to notice your new joint. Most hip and knee implants set off walk-through metal detectors, and body scanners usually highlight the area for a quick pat-down. TSA does not need an implant card, a letter or medical records. Before you step through, tell the officer where your implant is, for example, “I have a knee replacement on the left.” A wand or a brief pat-down over the joint follows, you stay clothed, and you can ask for private screening or a chair if standing is uncomfortable. The screening cannot harm the implant. Read more about airport metal detectors after joint replacement.

You leave with written instructions on what is normal, what to watch for and whom to call. Save these numbers in your phone before you fly:

• The office: (808) 439-6201, Monday to Friday, 8:00 am to 4:30 pm HST.
• After hours: the Physicians Exchange at (808) 524-2575, which reaches the on-call team.
• Emergencies: 911, for example for chest pain or sudden shortness of breath.

Call the office the same day about spreading redness around the incision, drainage that increases, fever or chills, new calf pain or swelling, or pain that gets worse after it had been improving. When you call, have your surgery date, which joint, your medication list and, for a wound question, a photo of the incision. The when-to-call guide and wound care page go into more detail.

The team stays in contact with you and your physician at home, coordinates with doctors on your island and works to get you seen locally quickly when needed. Follow-up visits continue by video while you are in Hawai‘i: the office texts a Doximity link, and you join on your iPhone or Android phone. Over the long term, a yearly X-ray keeps watch on the implant; see implant surveillance.

On Hawai‘i Island, most routine hip and knee replacements no longer involve a flight. Consultations, pre-operative visits and follow-up happen at the Hilo or Kona clinic on clinic days, so call for the current schedule. Video visits cover the gaps, and imaging is done on the island.

For most of these patients, surgery is at Hilo Community Surgery Center, where Dr. Morton performs Mako robotic hip, knee and partial knee replacements himself, each planned from a CT scan of your joint taken beforehand without IV contrast. The center is same-day only, with no overnight stay, so plan on a companion who takes you home and stays at least the first 24 to 72 hours.

Some operations belong in a hospital. If your health may call for a night of monitoring, or your case is a complex revision, the operation is scheduled from the outset at a hospital on O‘ahu, such as Queen’s, and the travel advice above applies to you. Your consultation and later follow-up still happen in Hilo or Kona.

West Hawai‘i patients should plan for the drive across the island on surgery day. Ask the team before surgery day whether to spend that first night in lodging near Hilo, since the surgery center itself has no overnight stay, or to ride straight home. The Hawai‘i Island areas page covers each part of the island.

Use this list in the weeks before your trip. Not every item applies to every patient, and your written instructions come first.

• Photo ID, insurance card and a current medication list.
• Medicines for the whole trip, plus some extra, in a bag that stays with you.
• Imaging uploaded, or confirmed as retrieved by the office.
• Any pre-operative tests done near home, with results sent to the office.
• A written list of every appointment: pre-operative visit, surgery, first post-operative check and clearance.
• Changeable flights, with wheelchair or cart assistance requested.
• Lodging with an elevator, an ADA-compliant bathroom and room for your companion.
• A ride for every appointment, and someone to meet you at your home airport.
• A companion for the trip and the first days.
• A walker plan for the trip and for home.
• Loose clothing or shorts and comfortable, supportive shoes.
• Your CPAP, if you use one.
• A charged phone, with the office holding your current mobile number for video-visit texts.
• A first appointment booked with your physical therapist at home.
• The office, after-hours and emergency numbers saved in your phone.