Can You Have Both Hips Replaced at the Same Time?

When both of your hips hurt, it's one of the first questions patients ask me: “Can you just replace both hips at the same time and get it over with?” It's a completely reasonable thing to want — one surgery, one anesthetic, one recovery. So let me answer it directly, and then tell you honestly why my recommendation is usually different.

The short answer: yes, but it's usually not what I recommend

It is technically possible to replace both hips in a single operation — surgeons call it a simultaneous (or single-stage) bilateral hip replacement. Both hips are done under one anesthetic, in one trip to the operating room. People do it, and for the right patient it can go well.

But “can” and “should” aren't the same question. Doing both hips at once concentrates all of the blood loss, anesthesia, and recovery into a single event — and asks more of your body than doing them one at a time. For the large majority of patients, I recommend a staged approach instead: replace one hip, let you recover, then replace the second about four weeks later.

What “at the same time” actually means

When patients picture having both hips done together, they're usually imagining the convenience of a single recovery. It helps to be precise about the two real options:

• Simultaneous (single-stage) bilateral hip replacement — both hips replaced in one operation, under one anesthetic. This is “both at the same time” in the literal sense.
• Staged bilateral hip replacement — the hips are replaced in two separate, shorter operations a few weeks apart. This is what I recommend for nearly all patients.

Both get you to the same finish line — two new hips in a short overall window. The difference is how much your body has to absorb at once, and whether you have a recovered leg to lean on while you heal. For a fuller walk-through of the whole decision, see my guide to double (bilateral) hip replacement.

Why doing both at once is harder on the body

A single-stage bilateral operation roughly doubles what a single hip replacement asks of you, all in one sitting. That shows up in a few concrete ways:

• Higher transfusion rates and more anemia. Replacing both hips at once means roughly twice the blood loss of a single hip. The chance of needing a blood transfusion is meaningfully higher, and you'll typically be more anemic afterward — which is exactly what saps your energy and slows you down in the first weeks, when you most need to be up and moving.
• A possibly higher clot risk. Some studies suggest the risk of blood clots — including a pulmonary embolism (PE), a clot that travels to the lungs — may be slightly higher with simultaneous bilateral surgery. The data aren't unanimous, but when a risk like that might be higher and the alternative (staging) is so straightforward, I take it seriously. (More on how we prevent clots either way in my article on aspirin and blood thinners after joint replacement.)
• More physiologic stress in one event. A longer operation and more anesthesia time ask more of the heart and lungs at once — which is why who you are medically matters so much for this choice.
• No good leg to lean on. This is the one I emphasize most. In the critical early days, recovery depends on being able to offload one leg while the other heals. If both hips are operated at the same time, neither leg can rest — both are sore and healing together, which makes standing, walking, and rehab harder on each side.

Who might be a candidate for doing both at once?

Simultaneous bilateral hip replacement isn't wrong in every case. For the right person, it can be a reasonable choice — and the deciding factor is patient selection. The patients I'd even consider for a single-stage operation tend to share a profile:

If that's not you — and for most people with two arthritic hips, it isn't a perfect fit — staging is the safer path. I'd rather be honest with you up front about whether you're truly a candidate than talk you into doing it the hard way. Wondering whether you'll even need the second hip at all? That's its own question — see will I need my other hip replaced?

Why I usually stage the hips about four weeks apart

For the large majority of patients, I stage the two hips about four weeks apart — sometimes stretching to six, depending on how the first side is healing. It's a deliberate choice, not a scheduling convenience, and the advantages line up neatly against the risks above:

• Lower blood loss and transfusion risk on each shorter operation.
• Less anemia to fight through during recovery, so you have more energy when it counts.
• A recovered “good” leg to lean on while the second hip heals.
• Physical therapy that can focus fully on one hip during its most important window.

Four weeks is enough time to get well past the critical early recovery on the first hip, but short enough that you're not waiting months between them. The reason that window works so well is the technique: because I use a minimally invasive direct anterior approach and roughly 90% of my patients go home the same day, recovery on the first side is quick enough to comfortably proceed with the second. See outpatient (same-day) joint replacement for how that recovery actually goes.

In other words: you let one hip recover for a bit before you really push the other. You still get both hips done in a short overall window — just in two manageable steps instead of one demanding one.

From Dr. Harb

The wish to “get it all done at once” is one I completely understand, and I take it seriously. But my job is to give you the safest, most effective plan — and for almost everyone with two arthritic hips, that's a staged approach about four weeks apart, not a single operation. Doing both at once means higher transfusion and anemia rates, a possibly higher clot risk, and no good leg to lean on while you heal. There's no prize for doing it the hard way.

Learn more about hip replacement with Dr. Harb, the signs it may be time, and what to expect from a double hip replacement — then come see us when you're ready.