Hip & knee care in Kailua-Kona

Dr. Paul Morton was born and raised in Kea‘au and graduated from Kea‘au High School. He studied medicine at home, at UH’s John A. Burns School of Medicine, and spent half his third-year rotations on Hawai‘i Island. He trained in orthopedics at St. Luke’s University Health Network in Pennsylvania, where he was chief resident, then completed a University of Chicago fellowship in adult reconstruction, covering joint replacement, robotics and complex revision, and AO Trauma fellowship training in complex fractures at Charité – Universitätsmedizin Berlin. He is board certified, with FAAOS and FAAHKS after his name.

Kona has a place in that story. On March 3, 2022, at Kona Community Hospital, he performed Hawai‘i Island’s first robotic joint replacement. That is history; today his operations on the island take place in Hilo. What remains in Kona is this clinic, so people from Kailua-Kona, Keauhou, Waikoloa, Waimea, Kohala and South Kona can see a hip and knee replacement specialist without crossing the island. Read his full background.

The Hualalai Road office is where most of your care happens: the consultation and exam, a look at your imaging, joint injections and nonsurgical arthritis care, knee injuries such as ACL, meniscus and cartilage problems, your pre-op appointment, and the checks after surgery. Kona is staffed on set clinic days, not daily, and the office can tell you the current ones at (808) 439-6201.

Between those days, a video visit can fill in. A text from the office carries a Doximity link; tap it on your iPhone or Android phone at the appointment time. You need to be in Hawai‘i during the call, and an in-person exam always comes before any operation. X-rays and other studies are arranged at Kona-area facilities, and studies done at other Hawai‘i facilities can generally be pulled in electronically. If you hold discs or files from a mainland doctor, upload your images (opens in a new tab) ahead of time. An upload gives the office access to the pictures; it is neither a review nor a booking.

Knees worn in a single compartment, with a healthy ACL, good straightening and pain that persists despite therapy, medicines and injections, are candidates for a partial knee replacement. Dr. Morton does all four types: medial, lateral, patellofemoral and bicompartmental. Once arthritis reaches two or three compartments, the ACL is torn or missing, rheumatoid or another inflammatory arthritis is present, or deformity is severe, a total knee makes more sense. A partial is somewhat more likely to need revision someday; partial versus total knee explains that trade-off. Your standing X-rays and exam decide, not your age alone.

For a total knee, he nearly always uses the quadriceps-sparing subvastus approach, and no first-time knee gets a tourniquet. For hips, his standard is the direct anterior approach. Only the capsule around the joint is opened, so no muscle is cut or pulled off the bone, and hip precautions are usually unnecessary. If your anatomy allows, the incision can follow the bikini line. When earlier surgery, old hardware or deformity favors a different approach, he explains why.

On Hawai‘i Island, Dr. Morton replaces hips, knees and partial knees with the Mako robotic system. Each plan begins with a CT scan, done without IV contrast; for Kona-side patients it can be done at Hawai‘i Radiologic Associates, North Hawai‘i Community Hospital or Kona Community Hospital (HDRS in Honolulu can also do the scan), and the office tells you where yours is booked. The scan becomes a 3D model of your joint, and on it he chooses implant size and placement, and for a hip he also sets cup placement, stem size, leg length and offset. In the operating room, the arm shows him alignment and balance readings in real time and holds each step to the plan. The arm does not cut on its own or decide anything; the surgery is his. X-rays taken during the operation double-check leg length, though no technology guarantees equal legs. There is no separate patient fee for the robot: it is billed as an ordinary joint replacement, and your Medicare coverage stays the same. More on how he uses robotic planning.

Other surgeons send Dr. Morton much of his work: roughly half his practice is revision joint replacement, and his Revision Hip & Knee Clinic often evaluates implants put in on the mainland or abroad. If a replaced hip or knee aches, feels loose or gives way, the evaluation can begin at your Kona visit. The workup compares new X-rays with earlier ones, checks inflammation markers in the blood (ESR and CRP), samples joint fluid for culture if infection is possible, and pins down the implant’s model, size and whether it has been recalled. Nothing is revised without a diagnosis. Most revisions take place at a hospital, usually The Queen’s Medical Center in Honolulu; they can also be done at Adventist Health Castle on O‘ahu’s Windward side, and a very carefully selected few at Hilo Community Surgery Center. Wherever yours is done, your follow-up then comes home to Kona. Want only a second opinion? Send the image files themselves, not just radiology reports, one to two weeks before your visit. He re-reads them personally and puts his impression and options in writing, with no pressure to change surgeons.

Dr. Morton does not operate in Kona today. Most first-time hips, knees and partial knees from the west side are done at Hilo Community Surgery Center, so surgery day means a drive across the island rather than a flight to O‘ahu. It is strictly a same-day center, with no overnight beds. Discharge comes when you can walk safely with a walker, keep down food and fluids, and manage pain on pills. A companion takes you there and back and stays with you, overnight included, for at least the first 24 to 72 hours. Home is on the other side of the island, so ask the team ahead of time whether to sleep near Hilo that first night.

If a night of hospital monitoring might be needed, or the case is a revision or a complex reconstruction, the plan is built around an O‘ahu hospital, such as Queen’s or Adventist Health Castle, from the beginning; only a very carefully selected revision is done in Hilo. Which setting is yours depends on the procedure, your health and your insurance, and Dr. Morton explains the choice. See how a same-day joint replacement unfolds.

With Hilo as the venue, the travel is all by road. A common sequence: a first visit at the Kona clinic, the CT scan for your Mako plan, a pre-op appointment back in Kona, one trip across the island for the operation, and follow-ups starting about a week later, at the Kona clinic or by telehealth. Your regular doctor usually signs off on medical clearance. Any blood work or EKG your health requires is spelled out by the office, which can book it, and it is reasonable to ask for a lab on the Kona side.

If an O‘ahu hospital is the right place, expect a single trip in most cases. With the consultation, hands-on exam and imaging handled in Kona, the O‘ahu stay bundles final testing, the operation and early recovery, with no separate exam on O‘ahu. Occasionally a complex case needs one more visit, and you learn that before buying any tickets. Some Hawai‘i insurers help with interisland airfare and lodging when off-island care is medically necessary; the office can find out whether yours does. The travel guide lays out both routes.

Rehab does not mean returning to Hilo, or even coming into Kona. Choose any licensed physical therapist whose location suits you, whether near Kailua-Kona, up in Waimea or down in South Kona, and therapy can take place at their clinic or in your home. If you have no one in mind, the office can offer names, and either way Dr. Morton’s written rehab protocols go directly to your therapist. Sessions start a day or two after you are home. Most people rely on a walker for about the first couple of weeks, then step down to a cane as balance returns. Between Kona appointments, the team can check your wound and fine-tune therapy over video. Starting prehab before surgery makes the first sessions feel familiar.

Plan on about 10–14 days on O‘ahu after a joint replacement, staying through your first post-operative check. The flight home to Kona waits for the surgical team’s fit-to-fly clearance and is never on the day of the operation. Because your recovery decides that date, a changeable ticket is wise; the travel guide gives the usual planning range. Visiting patients usually choose a hotel or condo close to the Ala Moana clinic. Look for an elevator, flat sidewalks for short walks, room for whoever is helping you, and confirmed ADA features. You book flights and lodging yourself, or the Elite Recovery level of the Rapid Recovery Concierge can arrange them; travel costs are not included.

Ask the airline for a wheelchair or cart when you book. In flight, an aisle seat lets you stand and stretch; sip water and flex your ankles. Stay on the clot-prevention plan you were given, with no extra aspirin for the trip. The metal detector will probably sound; a word to the officer is all it takes. Have someone meet you in Kona.

You leave the surgery center or hospital with a written sheet of warning signs and phone numbers. The office number, (808) 439-6201, is answered Monday through Friday, 8:00 am to 4:30 pm, and Saturday, 8:00 am to 2:00 pm HST, and anything urgent is triaged by phone that day. Outside those hours, reach the Physicians Exchange at (808) 524-2575. Call 911 for chest pain, sudden breathlessness or fainting.

Plenty of worries can be settled from home: a quick video call lets the team see the wound, watch you walk and adjust your therapy. If a problem needs hands-on care, the team works with your West Hawai‘i physicians so you can be seen locally quickly. The when-to-call guide lists the warning signs, and wound management covers incision care.