01
Tell the story
Dr. Morton starts with what happened, what has changed, what you have already tried, and what you need your body to do again.
Revision knee replacement
When a knee replacement is painful, stiff, unstable, or not right.
A painful knee replacement should not be rushed into another surgery. We need to understand whether the problem is loosening, infection, stiffness, instability, wear, alignment, fracture, soft tissue pain, or something outside the knee.
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Board-certifiedFellowship-trainedFAAOS / FAAHKSRobotic hip & kneeRevision expertiseHawaii roots
How the visit works
You should leave with a clearer plan than when you arrived.
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Look at the source
Your exam and imaging help separate arthritis, injury, implant problems, referred pain, and other causes that can feel similar.
03
Choose the next step
The plan may be therapy, bracing, injections, orthobiologics, arthroscopy, robotic surgery, revision workup, or a clear reason to wait.
Before you book
The first visit is better when the story is organized.
Joint Replacement Hawaii has always asked practical questions before the appointment because the details matter: what hurts, where it hurts, what you have tried, and what life activity you want back.
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What are you having trouble with?
Getting in and out of a car
Getting up from a chair
Stairs
Walking long distances
Pain at night
Exercise, sports, or work
02
What are you noticing?
Swelling
Instability or giving way
Stiffness or limited motion
Catching or locking
Grinding
Difficulty bearing weight
03
What have you already tried?
Physical therapy
Brace, cane, walker, or crutches
Steroid or gel injections
PRP or BMAC questions
NSAIDs or Tylenol
Prior arthroscopy or surgery
Before you decide
The conversation I want patients to understand.
01
When I usually see patients
Patients come in when the knee still hurts, never felt right, became unstable, lost motion, started swelling, or another surgeon has recommended revision.
02
What we review
We review X-rays, prior operative notes, implant information, labs, aspiration results when needed, CT scans when helpful, and your timeline from surgery to now.
03
What the visit should answer
The visit should explain what seems wrong, what is still unknown, and whether revision surgery, more testing, therapy, injections, or a different workup makes sense.
04
What would make me order more tests
A painful or stiff knee replacement may need infection labs, aspiration, CT, long-leg alignment X-rays, comparison films, or implant records before anyone can responsibly recommend revision.
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What would change the recovery plan
Bone loss, ligament damage, infection treatment, extensor mechanism problems, severe stiffness, or medical risk can make revision recovery different from a first knee replacement.
How I think through the recommendation
The decision should be explained, not handed to you.
Patients should know what would make us wait, what would make treatment reasonable, what might require more testing, and what changes recovery planning.
01
What may make us wait
- The pain source is not clear yet
- More records or labs are needed
- Another non-implant problem may explain the symptoms
02
What may make revision reasonable
- Clear loosening, instability, wear, fracture, or failed implant problem
- Infection workup has been addressed
- The expected benefit is worth the complexity
03
What may mean more tests
- ESR, CRP, aspiration, or culture questions
- CT scan for bone loss or implant position
- Old operative report or implant labels are missing
04
What changes recovery planning
- Bone loss, infection concern, or complex reconstruction
- Caregiver support and fall risk
- Longer restrictions than first-time replacement
Revision second opinion
Before another operation, we need to know why the implant hurts.
A painful hip or knee replacement can come from the implant, the bone, infection, instability, stiffness, the spine, or soft tissues. I want the story and records before we decide what another surgery can or cannot fix.
Think about 01
Bring the old records
Operative reports, implant labels, X-rays, labs, aspiration results, and a symptom timeline help us understand what changed.
Think about 02
Look for the real cause
Loosening, infection, wear, instability, stiffness, fracture, and referred pain can feel similar to patients but need very different plans.
Think about 03
Match the plan to the problem
Revision surgery only makes sense when it is aimed at the problem we can identify. If pain comes from somewhere else, we need a different answer.
For informed patients
The details matter, especially when the decision is not simple.
If you are comparing surgeons, robotics, revision care, injections, or recovery plans, these are the questions I want you to feel comfortable asking.
01
Revision workup
Painful implants need a reason. Records, labs, aspiration, CT, implant labels, and X-rays may all matter.
Infection rule-outLoosening and wear reviewBone loss planning
02
Second opinion value
Another operation should not be chosen until the likely cause and realistic benefit are clear.
Records-first reviewRisk and benefit discussionAlternatives when surgery is not the answer
Patient words
The trust signal should match the decision.
Patients are looking for listening, clear explanations, office kindness, and a plan that makes sense for their specific problem.
Patient trust
Painful implants need patience and records.
When a replacement hurts, the first job is to understand why. Old records, imaging, labs, and the patient's story can change the entire plan.
01
Revision hip and knee evaluation
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Painful implant second opinions
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Old operative report and implant review
You may be ready to schedule if
Persistent pain after knee replacement
Instability, giving way, stiffness, or swelling
Concern for loosening, wear, infection, or fracture
Considering another operation
The knee replacement is painful, stiff, swollen, unstable, or losing motion
You were told the knee may be loose, infected, worn, or malaligned
You need a careful second opinion before another operation
Why patients choose this practice
Complex revision hip and knee replacement is a major practice focus
Bring your old records so we can understand what changed
Second-opinion friendly visits for painful, stiff, unstable, or failed implants
Old operative notes, implant records, labs, and imaging can change the plan
Infection, loosening, instability, stiffness, wear, fracture, and spine sources are considered
A second-opinion visit can be useful even before you decide on revision surgery
Older patients and caregivers
Older patients and caregivers deserve a clear plan too.
Safety, medications, stairs, rides, hearing, memory, home help, and caregiver questions can change the recommendation and the recovery plan.
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Who should come with you
Bring the person who helps with medications, rides, meals, stairs, wound checks, or remembering instructions. A second set of ears helps.
02
How to plan home safety
Think about loose rugs, bathroom setup, stairs, lighting, pets, walking aids, shower safety, and where you will sleep the first few nights.
03
When to call the office
Call for worsening wound redness, drainage, fever, severe swelling, a fall, medication confusion, or symptoms that do not match your instructions.
04
When not to wait
Chest pain, shortness of breath, fainting, stroke-like symptoms, major deformity, or dangerous symptoms need emergency care.
Helpful to bring
X-rays, MRI, CT scans, or reports if you already have them
Where the pain starts, where it travels, and what it stops you from doing
Prior injections, therapy, medications, braces, or operations
Your goals for work, walking, golf, hiking, sports, travel, and recovery
Make the visit count
Bring the story, not just the scan.
Imaging helps, but the story matters too: what changed, what you tried, what failed, and what life you want back. This is especially important for revision opinions, prior surgery, and neighbor island travel.
Recovery preview
Prepare for revision recovery
Revision patients often need more records, more planning, and more caregiver support than first-time replacement patients.
Records-first planning
Complex restrictions
Warning signs
Patient questions
Questions I hear in the office.
Do all painful knee replacements need revision?
No. Some do, but the cause has to be clear before another surgery is planned.
What if I do not have my operative report?
Bring what you have. My team can tell you what records would be most useful to request.
Is revision harder than the first knee replacement?
Usually, yes. Revision surgery takes more planning because bone, implants, ligaments, and scar tissue may all be involved.
Mahalo
You do not have to figure this out alone.
If pain, injury, arthritis, or an old implant is keeping you from life, bring your questions. Dr. Morton and the team will help you understand the problem and the next step.
Written for patients by the practice
Orthopedic guidance should be clear enough to help you make a real decision.
Dr. Paul Norio Morton created Joint Replacement Hawaii to help patients understand hip pain, knee pain, arthritis, sports injuries, robotic joint replacement, revision surgery, injections, and recovery before they come in for a visit.
