Surgery

Dr. Paul Norio Morton and the team at Wiki Wiki Orthopedics in Honolulu, Hawaii, have been expertly trained at top-tier institutions to provide exceptional surgical treatment. Our team carefully evaluates each patient and injury to develop a personalized plan, whether non-surgical or surgical, that best suits their needs. Depending on the injury, surgery may be recommended to help maintain an active lifestyle and prevent further complications. Below are some of the most common surgical procedures we offer, but please call our office or schedule a consultation to discuss options tailored to your specific injury.

Knee Surgery

Knee Arthroscopy

Knee arthroscopy is a minimally invasive surgical procedure that involves making a small incision in the knee to insert a miniaturized camera into the joint. This technique allows the surgeon to diagnose the cause of knee pain and perform corrective procedures using specialized instruments. Arthroscopic surgery is commonly used for issues involving cartilage, the meniscus, or cruciate ligaments.

Procedure Details

Once a diagnosis is made, the surgeon can treat and repair the knee problem using various instruments through the arthroscopic ports. Potential repairs include cartilage repair, meniscal repair or removal, removal of Baker's cyst, removal of loose bone fragments, removal of medial plica, and reconstruction or repair of a torn cruciate ligament.

After the Surgery

Knee arthroscopy is a standard procedure with a low complication rate. It is typically performed on an outpatient basis, allowing patients to return home the same day. Recovery depends on the type of repair performed and may involve pain medications, physical therapy, or a brace.

Anterior Cruciate Ligament Reconstruction

The anterior cruciate ligament (ACL) is a crucial stabilizer within the knee and is prone to injury during pivoting movements common in sports like skiing, soccer, basketball, and others. Depending on factors such as age and activity level, surgical fixation may be recommended by the surgeon. Many full ACL tears in young, active individuals are treated with arthroscopic surgical repair and graft placement.

ACL reconstructions are outpatient procedures that involve a minimally invasive knee arthroscopy followed by graft placement. Graft options include cadaver tendon, patellar tendon, or hamstring tendon. The choice of graft is carefully considered in collaboration between the surgeon and the patient.

After the Surgery

Post-surgery, patients undergo a recovery process guided by an expert physical therapist. With time and diligent rehabilitation, these patients can return to a healthy, full, active lifestyle.

Meniscus Repair and Meniscal Debridement

The meniscus, a vital piece of cartilage in the knee, plays a crucial role in stabilizing the joint and absorbing impact and twisting motions. Unfortunately, it's also one of the most commonly affected tissues in the knee and is prone to tearing when the knee joint undergoes twisting movements during physical activities. A torn meniscus can lead to chronic pain and may require surgical intervention if conservative treatments fail to alleviate symptoms.

Surgical Procedure

Using a minimally invasive arthroscopic procedure, the surgeon can visualize the meniscus and assess the type, location, and extent of the tear. The primary goal of the surgeon is to preserve and repair the meniscus whenever possible, as it helps protect the knee from arthritis. If the tear is repairable, the surgeon will place small sutures to mend the meniscus. However, if the tear is not amenable to repair, a portion of the torn meniscus causing symptoms may need to be removed, a procedure known as a meniscectomy.

After the Surgery

Most patients are discharged on the same day following the procedure. If a meniscal repair was performed, the patient will be fitted with a knee brace for approximately 6 weeks and will gradually return to activity under the guidance of a physical therapist. After a meniscectomy, patients will work with an expert physical therapist to gradually resume activity without the need for a knee brace.

Cartilage Repair

Cartilage in the knee plays a crucial role in shock absorption and facilitating smooth movement. Injuries to the cartilage are common and can involve damage to the articular cartilage, which covers the ends of the leg bones, or tears in the wedge-shaped cartilage between the leg bones, known as the meniscus.

Treatment Options

The treatment for cartilage injuries depends on the type and severity of the tear. In some cases, debridement (removal of damaged tissue) may be sufficient, while in others, replacement may be necessary. Common procedures for cartilage repair include Matrix-associated autologous chondrocyte implantation (MACI) and others. These procedures aim to promote cartilage regeneration and restore normal joint function.

Individualized Care

Dr. Paul Norio Morton and the team at Wiki Wiki Orthopedics are dedicated to providing individualized care tailored to each patient's unique needs. We understand that every case is different, and we are here to discuss the best treatment options for you. Contact us to schedule a consultation and explore the best course of action for your cartilage injury.

Multiligament Knee Reconstructions

The knee joint relies on four main ligaments to maintain stability: two cruciate ligaments within the joint and two collateral ligaments on the sides. Injuries to the knee can sometimes involve the tearing of more than one of these ligaments simultaneously, leading to overall instability within the knee.

#### Treatment Approach

Depending on the severity of the injury, the surgeon may initially recommend a trial of conservative management for approximately 6 weeks to allow one of the ligaments to heal before considering surgical intervention. However, in cases where multiple ligaments are torn or if conservative measures fail to improve stability, a surgical procedure may be necessary.

Surgical Procedure

Multiligament knee reconstructions involve reconstructing all torn ligaments at once to restore stability to the knee joint. These procedures are considered standard for addressing complex knee injuries and can be performed with minimal incisions and low complication rates.

After the Surgery

Post-surgery, patients undergo a rehabilitation program under the guidance of an expert physical therapist to gradually regain strength, mobility, and function in the knee joint. With diligent rehabilitation, most patients can expect a return to an active lifestyle with improved knee stability.

Other Procedures That are Performed

Wiki Wiki Orthopedics in Honolulu, Hawaii, offers a wide range of knee treatments tailored to your needs. From MCL and PCL reconstructions to meniscal transplants and more, Dr. Paul Norio Morton team provide expert care to get you back on your feet. Contact us today to discuss your options and start your journey to a healthier knee.

Total Knee Replacements

Total Knee Arthroplasty (TKA)

Total Knee Arthroplasty, commonly known as Total Knee Replacement, is a surgical procedure where the damaged knee joint is replaced with an artificial joint. This procedure is typically recommended for patients with severe arthritis, significant knee damage, or chronic knee pain that hasn't responded to other treatments. The goal of TKA is to relieve pain, improve joint function, and enhance the patient’s quality of life.

Preoperative Assessment and Planning

Before undergoing TKA, a comprehensive preoperative assessment is essential. This includes a detailed evaluation of the patient’s medical history, a thorough physical examination, and imaging studies such as X-rays or MRIs. The surgeon will assess the alignment, stability, and range of motion of the knee. Preoperative planning also involves discussing the patient’s expectations, potential risks, and the anticipated recovery process.

Implant Selection

Choosing the appropriate type and size of the knee prosthesis is a critical step in ensuring the success of the surgery. The implants are usually made of metal and plastic components designed to mimic the natural movement of a knee. Factors considered in implant selection include the patient’s age, activity level, weight, and overall health. Customizing the implant to fit the patient’s unique anatomy helps to ensure better outcomes and longevity of the prosthetic knee.

Surgical Procedure

The surgical procedure typically lasts a few hours and is performed under anesthesia. It involves making an incision over the knee to access the joint. The damaged cartilage and bone from the surface of the knee joint are carefully removed. The surgeon then prepares the remaining bone surfaces and positions the prosthetic components, which include a metal femoral component, a metal tibial component, and a plastic spacer that fits between them. The components are secured in place, and the incision is closed with sutures or staples.

Postoperative Care and Rehabilitation

Postoperative care and rehabilitation are crucial for a successful recovery. Initially, patients will stay in the hospital for a few days to manage pain and begin physical therapy. Early movement is encouraged to prevent complications such as blood clots and to start the process of regaining knee function. A tailored rehabilitation program is designed to restore strength, flexibility, and mobility in the knee. This includes exercises, walking aids, and gradual progression to normal activities over several weeks to months.

Long-term Outcomes

Long-term outcomes of Total Knee Replacement are generally very positive. Most patients experience significant pain relief, improved function, and enhanced quality of life. Regular follow-up appointments are necessary to monitor the progress of the knee replacement and to address any issues that may arise. The majority of knee prostheses last 15-20 years or longer, allowing patients to return to many of their daily activities with minimal or no pain.

Lifestyle Modifications

After recovery, patients may need to make certain lifestyle modifications to protect their new knee. This includes maintaining a healthy weight, engaging in low-impact exercises such as swimming or cycling, and avoiding high-impact activities that can put excessive stress on the knee joint. Adhering to these recommendations can help prolong the lifespan of the knee replacement and maintain joint function.

Partial Knee Replacements

Partial Knee Arthroplasty (PKA)

Partial Knee Arthroplasty, also known as Partial Knee Replacement, is a surgical procedure where only the damaged compartment of the knee is replaced, rather than the entire knee joint. This option is often suitable for patients with osteoarthritis confined to a specific area of the knee. PKA aims to relieve pain and restore function while preserving as much of the natural knee as possible.

Preoperative Assessment and Planning

A thorough preoperative assessment is crucial to determine if a patient is a candidate for Partial Knee Replacement. This involves evaluating the patient’s medical history, conducting a physical examination, and using imaging studies like X-rays or MRIs to assess the extent and location of the knee damage. The surgeon will evaluate the alignment, stability, and range of motion of the knee. Detailed preoperative planning ensures that the procedure is tailored to the patient’s specific needs.

Implant Selection

Choosing the appropriate type and size of the implant is critical for a successful Partial Knee Replacement. Implants for PKA are designed to replace only the damaged part of the knee, such as the medial (inner), lateral (outer), or patellofemoral (front) compartment. The selection process considers the patient’s anatomy, activity level, and overall health. The goal is to select an implant that fits well and functions like the natural knee.

Surgical Procedure

The surgical procedure for PKA is typically less invasive than total knee replacement and can be performed under regional or general anesthesia. The surgeon makes a smaller incision over the knee and removes only the damaged cartilage and bone from the affected compartment. The remaining healthy bone and cartilage are preserved. The prosthetic components, usually made of metal and plastic, are then implanted to replace the damaged area. The incision is closed with sutures or staples, and the patient is monitored in recovery.

Postoperative Care and Rehabilitation

Postoperative care and rehabilitation are essential for a successful outcome. Patients typically experience a shorter hospital stay and quicker recovery time compared to total knee replacement. Early mobilization and physical therapy are crucial to regain strength, flexibility, and mobility in the knee. A personalized rehabilitation program includes exercises and gradual progression to normal activities. Pain management and wound care are also important aspects of postoperative care.

Long-term Outcomes

Long-term outcomes of Partial Knee Replacement are generally very favorable. Patients often experience significant pain relief and improved knee function, allowing them to return to their daily activities with less discomfort. Follow-up appointments are necessary to monitor the progress and ensure the implant is functioning well. With proper care, partial knee replacements can last many years, although some patients may eventually require a total knee replacement if arthritis progresses to other parts of the knee.

Lifestyle Modifications

After recovery, patients may need to make certain lifestyle modifications to protect their new knee implant. This includes maintaining a healthy weight, engaging in low-impact activities like walking, swimming, or cycling, and avoiding high-impact sports or activities that can stress the knee joint. Adhering to these recommendations can help prolong the lifespan of the partial knee replacement and maintain joint function.

Total Hip Replacements

Total Hip Arthroplasty (THA)

Total Hip Arthroplasty, commonly known as Total Hip Replacement, is a surgical procedure where the damaged hip joint is replaced with an artificial joint. This procedure is typically recommended for patients with severe arthritis, significant hip damage, or chronic hip pain that hasn't responded to other treatments. The goal of THA is to relieve pain, improve joint function, and enhance the patient’s quality of life.

Preoperative Assessment and Planning

Before undergoing THA, a comprehensive preoperative assessment is essential. This includes a detailed evaluation of the patient’s medical history, a thorough physical examination, and imaging studies such as X-rays or MRIs. The surgeon will assess the extent of the damage and plan the surgery accordingly. Preoperative planning also involves discussing the patient’s expectations, potential risks, and the anticipated recovery process.

Implant Selection

Choosing the appropriate type and size of the hip prosthesis is a critical step in ensuring the success of the surgery. The implants are usually made of metal, ceramic, and plastic components designed to mimic the natural movement of a hip joint. Factors considered in implant selection include the patient’s age, activity level, weight, and overall health. Customizing the implant to fit the patient’s unique anatomy helps to ensure better outcomes and longevity of the prosthetic hip.

Surgical Procedure

The surgical procedure typically lasts a few hours and is performed under regional or general anesthesia. It involves making an incision over the hip to access the joint. The damaged cartilage and bone from the surface of the hip joint are carefully removed. The surgeon then prepares the remaining bone surfaces and positions the prosthetic components, which include a metal stem that fits into the thigh bone, a metal or ceramic ball that replaces the femoral head, and a plastic or ceramic socket that replaces the acetabulum. The components are secured in place, and the incision is closed with sutures or staples.

Postoperative Care and Rehabilitation

Postoperative care and rehabilitation are crucial for a successful recovery. Initially, patients will stay in the hospital for a few days to manage pain and begin physical therapy. Early movement is encouraged to prevent complications such as blood clots and to start the process of regaining hip function. A tailored rehabilitation program is designed to restore strength, flexibility, and mobility in the hip. This includes exercises, walking aids, and gradual progression to normal activities over several weeks to months.

Long-term Outcomes

Long-term outcomes of Total Hip Replacement are generally very positive. Most patients experience significant pain relief, improved function, and enhanced quality of life. Regular follow-up appointments are necessary to monitor the progress of the hip replacement and to address any issues that may arise. The majority of hip prostheses last 15-20 years or longer, allowing patients to return to many of their daily activities with minimal or no pain.

Lifestyle Modifications

After recovery, patients may need to make certain lifestyle modifications to protect their new hip. This includes maintaining a healthy weight, engaging in low-impact exercises such as swimming or cycling, and avoiding high-impact activities that can put excessive stress on the hip joint. Adhering to these recommendations can help prolong the lifespan of the hip replacement and maintain joint function.

Hip Arthroscopy

Hip arthroscopy is a minimally invasive surgical procedure used to diagnose and treat problems within the hip joint. During this procedure, a small camera called an arthroscope is inserted into the hip joint through a small incision. This allows the surgeon to view the inside of the hip on a screen and perform necessary repairs using small instruments.

Indications for Hip Arthroscopy

Hip arthroscopy is typically recommended for patients with hip pain that has not responded to non-surgical treatments such as physical therapy, medications, or injections. Conditions that can be treated with hip arthroscopy include:

Labral Tears: Tears in the ring of cartilage (labrum) that follows the outside rim of the hip joint socket.
Femoroacetabular Impingement (FAI): A condition where extra bone grows along one or both of the bones that form the hip joint, causing friction and damage.
Hip Dysplasia: A condition where the hip socket is shallow, leading to joint instability.
Synovitis: Inflammation of the synovial membrane that lines the joint.
Loose Bodies: Small fragments of bone or cartilage that are loose in the joint space.
Ligamentum Teres Injuries: Damage to the ligamentum teres, a ligament in the hip joint.
Cartilage Damage: Damage to the cartilage inside the hip joint.

Preoperative Assessment and Planning

Before undergoing hip arthroscopy, a thorough preoperative assessment is conducted. This includes reviewing the patient's medical history, performing a physical examination, and obtaining imaging studies such as X-rays, MRI, or CT scans to evaluate the condition of the hip joint. Preoperative planning involves discussing the patient’s symptoms, the surgical procedure, potential risks, and the expected recovery process.

Surgical Procedure

The surgical procedure is typically performed under regional or general anesthesia. During hip arthroscopy:

Incisions: Small incisions (portals) are made around the hip area to insert the arthroscope and surgical instruments.
Visualization: The arthroscope is inserted into the hip joint, and the surgeon visualizes the interior of the joint on a monitor.
Treatment: Depending on the diagnosis, various procedures can be performed, such as trimming or repairing the labrum, removing bone spurs, smoothing damaged cartilage, removing loose bodies, or repairing torn ligaments.
Completion: Once the necessary repairs are made, the instruments are removed, and the incisions are closed with sutures or steri-strips.

Postoperative Care and Rehabilitation

Postoperative care and rehabilitation are crucial for a successful recovery. Key aspects include:

Pain Management: Medications are prescribed to manage pain and reduce inflammation.
Weight Bearing: Instructions on weight-bearing status will be provided. Crutches or a walker may be necessary for a period of time.
Physical Therapy: A tailored rehabilitation program will be designed to restore hip function, strength, and mobility. This includes exercises to improve range of motion, strength training, and gradual return to activities.
Follow-Up: Regular follow-up appointments with the surgeon to monitor progress and address any concerns.

Long-term Outcomes

Long-term outcomes of hip arthroscopy are generally favorable, especially when the procedure is performed for appropriate indications. Most patients experience significant pain relief and improved hip function, allowing them to return to their daily activities and sports. However, the success of the procedure can depend on factors such as the extent of joint damage, the specific condition treated, and the patient's adherence to postoperative rehabilitation.

Elbow Surgery

Distal Biceps Repair

The biceps muscle, situated in the front portion of the arm, plays a vital role in forearm flexion and rotation, crucial for lifting and daily activities. While tendinitis from repetitive lifting can often be managed conservatively, acute injuries such as partial or complete tears of the biceps tendon may require surgical intervention.

Diagnosis of a biceps tendon tear is typically confirmed through MRI imaging. Depending on factors like age and activity level, treatment options range from conservative management to surgical repair.

Surgical distal biceps repair involves making a small incision in the forearm, retrieving the retracted and torn tendon, and securing it to the bone with stitches. Following surgery, patients are placed in an elbow range of motion brace and undergo a gradual return to activity over approximately three months with the guidance of physical therapy.

If you're experiencing symptoms or have concerns about a distal biceps injury, consult with our expert team at Wiki Wiki Orthopedics in Honolulu, Hawaii, to explore the best treatment options for you.

Lateral Epicondyle Debridement/ Repair

The lateral epicondyle, located on the outer side of the elbow, can be prone to overuse injuries, causing discomfort and limited mobility. Conditions like lateral epicondylitis, commonly known as tennis elbow, can result in pain and inflammation in this area.

When conservative treatments such as rest, ice, and physical therapy fail to provide relief, lateral epicondyle debridement or repair may be recommended.

During the procedure, damaged tissue around the lateral epicondyle is removed (debridement) to alleviate symptoms. In cases of severe damage or tears, surgical repair may be necessary to restore function and stability to the elbow.

Following surgery, patients typically undergo a period of rehabilitation to strengthen the elbow and improve range of motion. Our team at Wiki Wiki Orthopedics in Honolulu, Hawaii, is here to provide expert care and guide you through the process of relieving elbow pain and restoring function. Contact us to schedule a consultation and explore your treatment options.

Ulnar Nerve Transposition

The ulnar nerve, responsible for sensation and movement in the hand and forearm, can become compressed or irritated at the elbow, leading to symptoms like numbness, tingling, and weakness. Ulnar nerve transposition is a surgical procedure aimed at relieving this compression and restoring normal nerve function.

During the procedure, the ulnar nerve is carefully moved from its original location to a new position in the arm, away from the compressed area. This relocation alleviates pressure on the nerve and reduces symptoms.

Ulnar nerve transposition is typically recommended when conservative treatments fail to provide relief or when symptoms are severe. Following surgery, patients undergo a period of rehabilitation to regain strength and mobility in the affected arm.

If you're experiencing symptoms of ulnar nerve compression, our team at Wiki Wiki Orthopedics in Honolulu, Hawaii, is here to provide expert care and support. Contact us to schedule a consultation and explore your treatment options.

Other: Triceps Repair

Feel free to get in touch with Wiki Wiki Orthopedics in Honolulu, Hawaii, if you’re interested in scheduling any of the procedures mentioned above with one of our skilled surgeons like Dr. Paul Norio Morton. We’re dedicated to providing personalized care and guidance throughout your orthopedic journey.

Hand & Wrist Surgery

Carpal Tunnel Release

Carpal tunnel syndrome, often a result of repetitive hand use, can lead to compression of the median nerve in the wrist's carpal tunnel, causing pain and numbness in multiple fingers. At Wiki Wiki Orthopedics in Honolulu, Hawaii, our team, led by experts like Dr. Paul Norio Morton, initially recommends conservative measures such as bracing, activity modification, anti-inflammatories, and corticosteroid injections.

While many patients find relief with these methods, some may continue to experience symptoms. In such cases, a routine surgical procedure known as carpal tunnel release may be recommended. During this outpatient procedure, a small incision is made in the wrist to release the carpal tunnel, alleviating compression on the median nerve and ideally resolving numbness and pain in the fingers.

Carpal tunnel release is associated with a low complication rate and patients typically return home within a few hours after surgery. Following a brief period of bandaging, patients can gradually resume their everyday activities. If you're experiencing symptoms of carpal tunnel syndrome, don't hesitate to reach out to us for expert care and support.

Trigger Finger Release

At Wiki Wiki Orthopedics in Honolulu, Hawaii, we understand the frustration that comes with trigger finger, a common condition caused by inflammation around the tendon sheath in the palm of the hand, known as the A1 pulley. This inflammation can lead to a locking sensation when attempting to straighten the finger, affecting daily activities.

Our initial approach involves conservative treatments like night splints, anti-inflammatories, and corticosteroid injections, which often provide relief. However, if symptoms persist, trigger finger release surgery may be recommended. This routine outpatient procedure, performed under local or general anesthesia, involves making a small incision in the palm of the hand to release the inflamed sheath and free the A1 pulley.

Patients typically experience excellent outcomes from trigger finger release surgery and can return to their normal activities quickly. If you're experiencing symptoms of trigger finger, contact us at Wiki Wiki Orthopedics to explore your treatment options and get back to pain-free living.

Surgical Release of De Quervain's Tenosynovitis

At Wiki Wiki Orthopedics in Honolulu, Hawaii, we understand the discomfort of De Quervain's tendinosis, a condition characterized by wrist pain on the thumb side due to tendon inflammation. This pain can radiate up the forearm, making certain activities challenging, particularly wrist bending and fist-making. While this repetitive use injury can affect anyone, it's especially common among new moms.

When conservative treatments prove ineffective, surgical release becomes a viable option. This delicate procedure involves making a small incision near the thumb on the wrist to release the affected tendons' soft tissue, allowing for improved mobility and symptom relief.

Following surgery, patients typically wear a bandage for 1-2 weeks before gradually resuming daily activities over the next 4-6 weeks under the guidance of a physical therapist. If you're experiencing symptoms of De Quervain's tendinosis, reach out to us at Wiki Wiki Orthopedics for personalized care and support.

Other:

Ankle & Foot Surgery

Achilles Tendon Rupture

At Wiki Wiki Orthopedics in Honolulu, Hawaii, we recognize the significance of an Achilles tendon rupture, a condition where the fibrous tissue connecting the calf muscle to the calcaneus tears either partially or completely, often due to high-impact sports injuries or heavy loading. Depending on the tear type and the patient's activity level, treatment options may involve conservative or surgical management.

If surgical intervention is deemed necessary, it's typically performed as an outpatient procedure. This involves making an incision in the back of the ankle and carefully suturing the torn ends of the tendon together.

Recovery from Achilles tendon repair is a process spanning 3-6 months. Initially, patients are non-weightbearing in a cast for approximately 6 weeks, followed by gradual transition to weightbearing in an elevated walking boot and extensive physical therapy. It's essential to consult with your orthopedic team to determine the most suitable treatment approach for you. Contact us at Wiki Wiki Orthopedics to discuss your options and receive personalized care and support.

Ankle Fracture

At Wiki Wiki Orthopedics in Honolulu, Hawaii, we understand the impact of an ankle fracture, which often occurs due to common inversion injuries affecting the tibia and fibula, specifically the lateral and medial malleolus bones that make up the ankle joint. Depending on the fracture type, instability may occur, necessitating surgical fixation to promote ankle stability and facilitate a return to normal activity levels.

Surgical fixation for ankle fractures typically involves open surgery, during which an incision is made near the fracture site to place a plate and screws over the fracture, aiding in the healing process.

Following surgery, patients are typically immobilized in a cast for 4-6 weeks before gradually resuming weightbearing and activities. At Wiki Wiki Orthopedics, our team is dedicated to providing personalized care and support throughout your recovery journey. Contact us to discuss your treatment options and receive expert orthopedic care.

Other: Trauma / Fracture Care

At Wiki Wiki Orthopedics in Honolulu, Hawaii, we provide comprehensive trauma and fracture care to patients of all ages. A fracture occurs when a bone is stressed or subjected to force beyond its capacity, resulting in a break. Treatment options vary depending on the fracture type and location.

Simple fractures with no displacement can often be managed conservatively, typically with immobilization. However, fractures with poor alignment, instability, or potential complications may require surgical intervention for optimal healing and stability. Surgical fixation, such as open reduction internal fixation (ORIF), involves realigning the bones using methods like plates, screws, intramedullary nails, or Kirschner wires.

Timing is crucial for surgical intervention, typically within 7-14 days of the initial fracture. Whether treated conservatively or surgically, fractures typically take 6 weeks to 3 months to heal completely. Following removal of any casts, patients work closely with physical therapists to regain strength and mobility, facilitating a return to normal activities.

At Wiki Wiki Orthopedics, our team is committed to providing expert care and support throughout the fracture healing process. Contact us to discuss your treatment options and receive personalized fracture care tailored to your needs.

Procedures:

ORIF clavicle (proximal / midshaft / distal)
ORIF proximal humerus
ORIF greater tuberosity fracture
ORIF humeral shaft
ORIF olecranon
ORIF radial head fracture
ORIF distal radius fracture
ORIF both bone forearm fractures
ORIF patellar fractures
ORIF tibial plateau fractures
ORIF bimalleolar ankle fractures
ORIF trimalleolar ankle fractures
ORIF distal fibular fractures
ORIF metatarsal fracture (Jones fractures)

Shoulder Surgery

Shoulder Arthroscopy

Shoulder arthroscopy is a minimally invasive surgical procedure involving two small incisions in the shoulder through which a tiny camera is inserted into the joint. This technique allows the surgeon to diagnose the cause of shoulder pain and perform corrective procedures using specialized instruments. Arthroscopic surgery is commonly used for issues involving cartilage, the labrum, shoulder impingement, or rotator cuff injuries.

After the Surgery:

Shoulder arthroscopy is a standard procedure with a low complication rate. Typically classified as an outpatient procedure, patients usually return home the same day. Recovery depends on the type of repair performed and may involve pain medications, physical therapy, or the use of a sling.

Total Shoulder Arthroplasty and Reverse Total Shoulder Arthroplasty

The shoulder is the body's most flexible joint, primarily composed of the glenohumeral joint where the humeral head meets the socket of the scapula, known as the glenoid. Over time, the cartilage between these bones can wear down, leading to osteoarthritis. This condition can cause pain, reduce the range of motion, and limit functionality. Initially, conservative treatments are recommended, but if daily activities remain restricted, a shoulder arthroplasty, or total shoulder replacement, might be advised.

Total Shoulder Arthroplasty:

Total shoulder arthroplasty is performed under general anesthesia. The procedure starts with an incision and careful separation of the muscles and bones in the shoulder joint. The damaged humeral head is removed, hollowed out, and filled with cement. A new metal ball with a stem is then placed into the bone. An artificial component is also implanted near the glenoid. Finally, the shoulder capsule, muscle, and skin are meticulously stitched closed.

Reverse Total Shoulder Arthroplasty:

Reverse total shoulder arthroplasty is similar to total shoulder arthroplasty but is designed for patients with both shoulder osteoarthritis and a rotator cuff tear. In this procedure, the placement of the metal ball and cup is reversed, allowing patients to use their deltoid muscle instead of the rotator cuff to maintain full range of motion in the shoulder.

After the Procedure:

Post-surgery, patients typically stay in the hospital for 24 hours, receiving pain medications and antibiotics to prevent infection. They are placed in a sling and can begin gently resuming activities with the guidance of an expert physical therapist. Rehabilitation usually lasts about 3-6 months.

Shoulder Arthroscopy:

After the Surgery:

Rotator Cuff Repair

The rotator cuff is comprised of four tendons: the supraspinatus, infraspinatus, subscapularis, and teres minor. These tendons play a crucial role in stabilizing the shoulder and enhancing its strength and range of motion. Rotator cuff injuries involve the partial or complete tearing of these tendons. While acute injuries often cause rotator cuff tears, chronic tears can result from age-related degenerative changes, overuse, or the cumulative effects of daily wear and tear. Such injuries can lead to shoulder pain and weakness, sometimes necessitating surgical intervention.

Advanced minimally invasive arthroscopic techniques have been developed for rotator cuff repair. This procedure involves visualizing the shoulder arthroscopically and using sutures to anchor the tendon to the bone. Post-surgery, patients are typically guided through gentle strengthening and range of motion exercises with the assistance of an expert physical therapist.

Labral Repair/Capsulorraphy

The labrum is a cup-shaped rim of cartilage on the glenoid that helps reinforce the bones of the shoulder. Labral tears can occur due to acute injuries or over time from repetitive use and wear and tear. Sometimes, the biceps tendon is also affected, resulting in a SLAP (Superior Labrum Anterior and Posterior) tear. Initially, labral tears are typically treated conservatively with rest, physical therapy, anti-inflammatory medications, and possibly corticosteroid injections. If symptoms persist, a labral repair or capsulorraphy may be recommended.

Labral repair is a minimally invasive arthroscopic surgery where the torn portion of the labrum is either removed or repaired. For SLAP tears, where the biceps tendon is involved, absorbable sutures are used to repair the tendon. After surgery, patients are usually placed in a sling and gradually return to range of motion and strengthening exercises under the guidance of an expert physical therapist.

AC Joint Reconstruction

The acromioclavicular (AC) joint is where the clavicle (collarbone) meets the acromion, which is part of the scapula (shoulder blade). Injuries to the AC joint, often referred to as shoulder separations, can occur due to trauma or overuse. These injuries can cause pain, instability, and limit shoulder function. When conservative treatments like rest, physical therapy, and anti-inflammatory medications do not provide relief, AC joint reconstruction may be recommended.

AC Joint Reconstruction Procedure:

AC joint reconstruction is a surgical procedure aimed at restoring the normal anatomy and function of the AC joint. The surgery typically involves the following steps:

Incision and Exposure: An incision is made over the AC joint to expose the damaged area.
Repair or Reconstruction: The damaged ligaments are either repaired or reconstructed using a graft. The graft can be taken from the patient's own tissue or from a donor.
Fixation: The graft is securely fixed to the clavicle and the acromion using screws, pins, or other fixation devices to stabilize the joint.
Closure: The incision is closed with sutures.

After the Surgery

Post-surgery, patients are usually placed in a sling to immobilize the shoulder and allow for proper healing. Pain management and antibiotics may be prescribed to prevent infection. Gradually, under the guidance of an expert physical therapist, patients will begin gentle range of motion and strengthening exercises. Full recovery and return to normal activities typically take several months, depending on the extent of the reconstruction and individual healing rates.

Other Procedures That are Performed

Dr. Paul Norio Morton at Wiki Wiki Orthopedics in Honolulu, Hawaii, specializes in a variety of surgical procedures for the shoulder, including:

Subacromial Decompression
Distal Clavicle Excision
Biceps Tenodesis
SLAP Repair
Pectoralis Tendon Repair
Debridement of Calcific Tendonitis

Please contact Wiki Wiki Orthopedics to discuss any of the above procedures and how they can help address your shoulder issues.

Total Shoulder Replacements

Total Shoulder Arthroplasty (TSA)

Total Shoulder Arthroplasty, commonly known as Total Shoulder Replacement, is a surgical procedure where the damaged parts of the shoulder joint are replaced with artificial components. This procedure is typically recommended for patients with severe shoulder arthritis, significant shoulder damage, or chronic shoulder pain that hasn't responded to other treatments. The goal of TSA is to relieve pain, improve joint function, and enhance the patient’s quality of life.

Indications for Total Shoulder Replacement

Total Shoulder Replacement is usually indicated for patients with the following conditions:

Osteoarthritis: Degenerative joint disease causing the breakdown of cartilage in the shoulder.
Rheumatoid Arthritis: An autoimmune condition leading to inflammation and damage of the shoulder joint.
Post-traumatic Arthritis: Arthritis resulting from a previous shoulder injury.
Rotator Cuff Tear Arthropathy: Severe arthritis and rotator cuff damage.
Avascular Necrosis: Loss of blood supply to the head of the humerus causing bone death and joint damage.
Severe Fractures: Complex fractures of the shoulder that cannot be repaired with other surgical methods.

Preoperative Assessment and Planning

A comprehensive preoperative assessment is essential before undergoing TSA. This includes a detailed evaluation of the patient’s medical history, a thorough physical examination, and imaging studies such as X-rays or MRIs to assess the extent of shoulder damage. The surgeon will evaluate the range of motion, strength, and stability of the shoulder. Preoperative planning also involves discussing the patient’s expectations, potential risks, and the anticipated recovery process.

Implant Selection

Choosing the appropriate type and size of the shoulder prosthesis is a critical step in ensuring the success of the surgery. The implants are typically made of metal and plastic components designed to mimic the natural movement of the shoulder. The main components include a metal ball that replaces the head of the humerus and a plastic socket that replaces the glenoid (shoulder socket). The selection process considers the patient’s anatomy, activity level, and overall health.

Surgical Procedure

The surgical procedure for TSA typically lasts a few hours and is performed under regional or general anesthesia. The steps involved include:

Incision: An incision is made over the shoulder to access the joint.
Removal of Damaged Tissue: The damaged cartilage and bone are carefully removed from the head of the humerus and the glenoid.
Implant Placement: The metal ball is attached to a stem that fits into the humerus, and the plastic socket is placed into the glenoid. These components are secured with bone cement or press-fit into the bone.
Closure: The incision is closed with sutures or staples, and the shoulder is bandaged.

Postoperative Care and Rehabilitation

Postoperative care and rehabilitation are crucial for a successful recovery. Key aspects include:

Pain Management: Medications are prescribed to manage pain and reduce inflammation.
Immobilization: The shoulder is usually immobilized in a sling for a few weeks to protect the repair.
Physical Therapy: A tailored rehabilitation program is designed to restore shoulder function, strength, and mobility. This includes exercises to improve range of motion and strength training.
Follow-Up: Regular follow-up appointments with the surgeon to monitor progress and address any concerns.

Long-term Outcomes

Long-term outcomes of Total Shoulder Replacement are generally very positive. Most patients experience significant pain relief, improved function, and enhanced quality of life. Regular follow-up appointments are necessary to monitor the progress of the shoulder replacement and to address any issues that may arise. The majority of shoulder prostheses last 15-20 years or longer, allowing patients to return to many of their daily activities with minimal or no pain.

Lifestyle Modifications

After recovery, patients may need to make certain lifestyle modifications to protect their new shoulder. This includes avoiding heavy lifting, engaging in low-impact exercises, and following the surgeon’s recommendations for shoulder care. Adhering to these guidelines can help prolong the lifespan of the shoulder replacement and maintain joint function.

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