Bilateral Hip Replacement: Can Both Hips Be Replaced at the Same Time?

Key Takeaways

• Both hips can be replaced under one anaesthetic, though this suits a narrower group of people than having each hip done separately.
• Simultaneous surgery means one hospital stay and one recovery, while staged surgery spreads the physical demand across two admissions.
• Large studies show broadly similar revision and mortality outcomes, with trade-offs in specific complications that a surgeon weighs against your health.
• Your fitness beforehand, your support at home and your rehabilitation plan shape the result as much as the timing does.

Standing up from a chair. Getting into the car. Walking the length of a supermarket aisle. When both hips are worn, there is no good side to lean on and no easy way to compensate. That is usually the point where bilateral hip replacement enters the conversation.

The short answer is yes. Replacing both hips under a single anaesthetic is an established procedure in Australia, and many people do well with it. It is not offered to everyone, though, and the decision rests on far more than convenience.

Understanding what each pathway asks of your body makes the conversation with your specialist more productive. It also helps to know the surgeon-led hip surgery options that sit alongside a full replacement, because any recommendation you receive will reflect your hips, your general health and your goals together.

What Bilateral Hip Replacement Means

‘Bilateral’ means both sides, and both hips are replaced under either plan. What varies is how far apart the two operations sit:

Simultaneous Surgery Under One Anaesthetic

Both hips are replaced in one theatre session, under a single anaesthetic, during a single hospital admission. The surgeon completes one side, then repositions and repeats on the other. Total operating time is longer than for a single hip, though usually shorter than two separate operations combined. There is one wound-healing period, one course of blood-clot prevention and one block of rehabilitation.

Staged Surgery Across Two Admissions

Each hip is replaced at a separate admission. Intervals commonly range from a few weeks to several months, and the timing is often set by how quickly the first hip settles. The second operation then proceeds with a strong, comfortable limb to stand on.

Shared Causes Behind Bilateral Wear

Hip osteoarthritis frequently affects both sides, particularly when the underlying cause is generalised joint wear, inflammatory arthritis, hip dysplasia or avascular necrosis. One hip is usually the louder of the two, and it can mask how far the quieter side has deteriorated until the first hip is fixed and the second is asked to do more.

Who May Be Considered for Both Hips at Once

Suitability for a single-stage procedure is assessed case by case, and most surgical teams apply tighter criteria than they would for a single hip. Several factors tend to carry the most weight:

General Health and Anaesthetic Tolerance

Replacing two hips means a longer time under anaesthetic and a larger physiological demand in one sitting. Heart and lung function, blood pressure control, diabetes management, kidney function and current medications are all reviewed. People assessed as lower risk are generally considered for a simultaneous procedure, and an anaesthetist is closely involved in that decision.

Severity and Symmetry of Hip Disease

A simultaneous procedure makes most sense when both hips are genuinely limiting daily life. Where one hip is severely arthritic and the other shows only mild changes on imaging without matching symptoms, operating on both may commit you to a procedure you did not yet need.

Bone Quality and Body Weight

Bone density influences how an implant is fixed and how the thigh bone tolerates preparation. Higher body weight increases the physical demand of moving when neither leg is fully reliable. Neither factor rules out a bilateral procedure on its own, though both may shift the balance towards staging.

Home Setting and Available Support

Recovering from two new hips at once means having no unaffected leg to favour, so your living arrangements carry more weight than they would after a single hip. Someone living alone in a multi-level home may recover more comfortably with a staged plan.

Surgical and Hospital Experience

Outcomes reported for simultaneous procedures generally come from teams that perform them regularly, with established anaesthetic, blood-management and rehabilitation pathways. It is fair to ask how often your surgeon performs bilateral procedures and what the hospital protocol involves.

What the Evidence Says About Doing Both Hips Together

Research comparing the two timings is substantial, though most of it comes from registry and observational data instead of randomised trials. The findings point to trade-offs, not a clear winner:

Complication Patterns Across Large Studies

A systematic review and meta-analysis of 38 studies covering 104,151 patients reported lower rates of deep vein thrombosis and of pulmonary, systemic and local complications in the simultaneous group. The same analysis found higher rates of pulmonary embolism and periprosthetic fracture in that group.

Rates of dislocation, deep joint infection and death within 90 days were similar between the two approaches. Complication rates were low in both groups.

Revision and Mortality in Australian Registry Data

An analysis of 12,359 bilateral hip replacement procedures reported to the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) found similar revision rates between simultaneous and staged surgery across most time intervals. Mortality within 30 days was low throughout, and lower still in the staged group.

AOANJRR data of this scale shows patterns across thousands of procedures, not what will happen in any one case.

Differences in Stay, Blood Loss and Cost

Pooled data showed a shorter total hospital stay for simultaneous surgery, averaging around 4.8 days less than the combined stays of two staged admissions. Total blood loss and overall cost were also lower, though transfusion rates were similar between the groups.

Limits of the Available Research

Almost all comparative studies are retrospective, and people selected for simultaneous surgery tend to be younger and healthier than those who are staged. That selection difference can flatter the simultaneous results. Definitions of complications also differ between studies and health systems, so the findings describe general direction more than precise risk for one person.

How Recovery Differs Between the Two Approaches

Doing both hips together is not simply twice the work of a single hip, though it does compress everything into one recovery. The differences show up across the recovery:

Managing the First Days After Surgery

After a single hip replacement, most people go home after three to five days, according to Healthdirect. A simultaneous bilateral procedure often extends that stay, because you are learning to move without a stronger side to lean on. You rely on walking aids for longer, and transfers in and out of bed, chairs and the car take more planning.

Sleeping and Positioning in the Early Weeks

Sleep is often disrupted after hip surgery, and with two operated sides there is no comfortable hip to roll onto. Many people sleep on their back with a pillow arrangement for the first weeks, and some surgical approaches carry specific positioning precautions that your team will explain before discharge.

Rebuilding Strength on Both Sides

With staged surgery, the unoperated leg carries more of the load while the new hip settles, although that leg is itself arthritic and tires quickly. With simultaneous surgery, both sides progress together, which can even out your walking pattern sooner because there is no strong-side habit to unlearn. Either way, hip abductor strength, single-leg control and walking endurance are rebuilt gradually across the first months.

Returning to Driving, Work and Daily Activity

Most people return to light daily activities after around six weeks and to most normal activities after about three months following a hip replacement. Bilateral surgery does not automatically double those figures, though it may lengthen the early phase when aids are needed. Driving after hip replacement depends on reaction time, comfort and vehicle control instead of a fixed date, and the same principles apply when both hips have been done.

Comparing Total Time Away From Normal Life

Two staged operations mean two pre-admission processes, two anaesthetics, two wounds and two rehabilitation blocks, often spread across six to 12 months. A simultaneous procedure compresses that into one, which appeals to people managing work commitments or travelling from regional areas for surgery. The trade-off is a steeper, more demanding start.

These timeframes are a general guide. Individual recovery varies with the surgical approach used, your health before surgery and how rehabilitation progresses.

How the Decision Is Made in Australia

The pathway to a bilateral procedure runs through several assessments, and the timing is usually confirmed late in that process, not at the first appointment:

Referral and Specialist Assessment

A general practitioner (GP) referral to an orthopaedic specialist starts the process. Assessment covers your symptoms, what you can no longer do comfortably, examination findings and imaging of both hips, alongside what non-surgical management has already been tried.

Pre-Admission and Anaesthetic Review

Pre-admission clinics review your medical history, medications, blood results and fitness for the length of anaesthetic proposed. A simultaneous procedure raises the threshold at this stage, and a plan changing from bilateral to staged after this review is a normal, protective outcome, not a setback.

Public and Private Pathway Differences

Waiting periods, hospital resources and inpatient rehabilitation options differ between the public and private systems, and those practicalities can influence timing. Private health insurance policies vary in what they cover for joint replacement and rehabilitation, so checking your level of cover and any waiting periods early avoids surprises later.

Consent and Risk Discussion

Consent involves talking through the risks specific to the procedure proposed for you, including infection, dislocation, blood clots, fracture, nerve injury and the possibility of a leg-length difference. The Therapeutic Goods Administration publishes five questions to ask before receiving an implant. The guidance is available in several community languages.

Questions Worth Asking Before You Decide

A recommendation carries more weight when you understand the reasoning behind it. Writing your questions down helps, because consultations move quickly:

• Why is a simultaneous or staged approach being suggested in my case?
• What does my current health mean for a longer time under anaesthetic?
• How often does this surgical team perform bilateral procedures?
• What will the hospital stay and discharge plan look like?
• What support will I need at home during the first fortnight?
• What happens if the second hip needs to be delayed?
• Which findings would change the recommendation?

Answers will differ between surgeons, and seeking a second opinion is a normal part of considering major surgery. Your GP can help you weigh the options against your broader health.

Preparing for Surgery on One or Both Hips

Preparation shapes recovery, and it counts for more when two joints are being replaced together. The stronger you are going in, the less ground there is to make up afterwards:

Strength Work Before Surgery

Targeted exercise before surgery, often called prehabilitation, aims to build hip and thigh strength, maintain what movement you have and rehearse the walking-aid technique you will use afterwards. A structured pre-surgery rehabilitation program can make the first attempts at standing, walking and stair practice feel familiar. Gains are expected to be modest when a hip is severely arthritic, and the purpose is preparation, not repair.

Health Improvements Before Admission

Doctors often suggest ways to improve your general health before surgery, since being in better condition can make recovery smoother and reduce the chance of complications. Blood sugar control, dental health, iron levels, skin condition around the hips and smoking status are commonly reviewed.

Small, sustainable changes made over the weeks before admission tend to be more achievable than an intense effort in the final days. Your GP is well placed to advise on which of these apply to you.

Practical Set-Up at Home

Clearing walkways, arranging a firm chair with armrests, sorting bathroom rails and moving frequently used items to waist height all make the first weeks easier. Where stairs cannot be avoided, practising a safe technique before surgery is worthwhile.

Support From Family and Carers

Someone available for shopping, driving and household tasks makes a difference after bilateral surgery. Arranging this before admission avoids scrambling for help in the week you are least able to organise it.

Rehabilitation Planning After Discharge

The weeks after hospital take shape once you know who will guide your rehabilitation, how often you will be seen and what the early milestones are. Progress does not always follow a straight line, and understanding what can delay recovery helps you read a slower week accurately without assuming something has gone wrong.

Deciding on One Operation or Two With Confidence

By the time both hips are dictating how your day runs, the worry is rarely about surgery itself. It is about making a choice you cannot take back, and then living with it.

That worry eases once the decision stops looking like a gamble. Neither pathway is reckless, and neither is overly cautious. They are two ways of solving the same problem, and the evidence supports both when the person is well matched to the plan. What sits within your control is the preparation you do, the questions you ask and the rehabilitation you commit to. Those choices shape the outcome more than the spacing of two dates on a calendar.

Standing, walking and getting on with your day without planning around your hips is a realistic goal.

When both hips are limiting how you move, the team at MTP Health can help you build strength beforehand and recover with a plan you understand. Speaking with your GP or an orthopaedic specialist is the right starting point for the surgical decision itself.

Frequently Asked Questions (FAQs)

1. Is bilateral hip replacement more painful than having one hip done?

Pain after surgery is managed with a combination of medications and early movement, and modern protocols aim to keep you comfortable enough to start walking quickly. Having two operated hips can make positioning and transfers harder in the first days, which some people experience as a tougher start.

Discomfort varies between individuals, so your surgical and anaesthetic team will tailor a pain-management plan to you.

2. How long does simultaneous bilateral hip replacement take?

Operating time depends on the approach used, your anatomy and whether the second side presents additional complexity. Your surgeon can give a realistic estimate once the surgical plan and implants are confirmed.

3. Will I be able to walk after having both hips replaced at once?

Most hospitals encourage walking with an aid within the first day or two after hip replacement, and that principle applies to bilateral procedures. Expect to progress in shorter, more frequent bouts at first.

4. What is the usual gap between staged hip replacements?

The interval depends on how the first hip recovers, your general health and hospital scheduling. Some surgeons prefer to wait until the first side is walking well and comfortable before booking the second, so the interval is often confirmed after your first review appointments.

5. Does having both hips replaced together cost more?

Research has generally found lower total costs for simultaneous surgery, largely through one admission and a shorter combined stay. What you personally pay depends on the public or private pathway, your level of insurance cover, hospital and prosthesis costs, and any specialist gap fees.

Requesting written informed financial consent before surgery gives you the full picture.

6. Can bilateral hip replacement be done using the anterior approach?

Simultaneous bilateral procedures have been reported using anterior, posterior and other approaches, and no single technique is suitable for everyone. The choice usually reflects your anatomy, your diagnosis and the technique your surgeon uses most consistently.

7. What if I have one hip replaced and the other becomes painful later?

This is a common sequence, and a second hip replacement months or years later is a routine procedure. Keeping the second hip strong and mobile in the meantime supports your walking pattern and can make that later surgery, if it is needed, more straightforward.

This article provides general information only. It does not take account of your medical history, symptoms, imaging or personal circumstances, and it is not a substitute for individual medical advice. Timeframes, complication figures and recovery expectations described here are drawn from published research and general guidance, and your own situation may differ. Please speak with your GP, orthopaedic specialist or another qualified health practitioner before making decisions about surgery or changing how you manage your hips.