Double (Bilateral) Hip Replacement: What to Expect

Most people who need a hip replacement only need one hip replaced. But arthritis doesn't always limit itself to one side — and if both of your hips are painful, it's natural to ask whether both can be addressed together. The short answer is yes: when severe arthritis affects both hips, a double (bilateral) hip replacement is an option. The more important question is how — and on that, I have a clear recommendation.

What is a double (bilateral) hip replacement?

A bilateral hip replacement simply means both hip joints are replaced, rather than one. It becomes a consideration when hip arthritis has significantly worn down both hips — when it's genuinely hard to say which hip is “the bad one,” because they're both telling you so. There are two ways to approach it:

• Staged bilateral hip replacement — the hips are replaced in two separate operations a few weeks apart. This is what I recommend for nearly all patients.
• Simultaneous bilateral hip replacement — both hips replaced during a single operation under one anesthetic. Possible, but reserved for a narrow group of very healthy patients.

My recommendation: stage the two hips

For the large majority of patients with arthritis in both hips, I recommend a staged approach — replace one hip, let you recover, then replace the second hip about 4–6 weeks later. This isn't a hedge or a scheduling convenience; it's a deliberate safety choice backed by how the body actually recovers.

Why staged is safer than doing both at once

Doing both hips in a single operation concentrates a great deal into one event. Staging spreads that out, and the advantages are concrete:

• Lower complication rate. Two shorter, focused operations are generally safer than one long bilateral procedure.
• Lower blood-transfusion rates. Replacing both hips at once meaningfully increases the likelihood of needing a transfusion; staging keeps blood loss per operation lower.
• Shorter operative and anesthesia time on each side — easier on the heart, lungs, and overall physiology.
• A recovered leg to rely on. This is the big one: in the critical early phase, you need to be able to offload one leg while the other heals. If both hips are operated at once, neither leg can rest — both are recovering simultaneously, which makes the early weeks harder and rehab slower on each side.
• Focused rehabilitation. Staging lets physical therapy concentrate fully on one hip during its most important recovery window.

By the time we do the second hip, you've recovered from the first — so you go into it strong, with a reliable leg to support you.

How far apart? About 4–6 weeks

I typically stage the second hip about 4–6 weeks after the first. That window is long enough to clear the critical early recovery on the first side, but short enough that both hips are addressed in a brief overall timeframe — you're not waiting months between them. Because I use a minimally invasive direct anterior approach and roughly 90% of my patients go home the same day, recovery from the first hip is quick enough to comfortably proceed with the second within that window. See outpatient (same-day) joint replacement for how that works.

What about doing both hips at once?

Simultaneous bilateral hip replacement isn't wrong in every case — for a young, very healthy, well-selected patient with two equally worn hips who strongly prefers a single recovery, it can be reasonable. But it asks a lot of the body in one sitting:

• Greater physiologic stress — a longer operation and more for the body to handle at once.
• Higher transfusion rates and more blood loss in a single event.
• A harder early recovery with no good leg to lean on.

For those reasons it's the exception in my practice, not the default. If you're set on a single recovery, I'll be honest with you about whether you're truly a candidate — and why staging is usually the safer choice. I walk through this exact decision in more detail in can you have both hips replaced at the same time?

Recovery after staged bilateral hip replacement

Staging means two shorter, more manageable recoveries rather than one demanding one. Each side follows the same rapid-recovery principles as a single hip replacement:

The broad arc mirrors our hip replacement recovery timeline, done twice but each time more easily than a simultaneous recovery. Preparing well makes a real difference — see how to prepare for surgery.

What patients commonly tell me

Patients with two arthritic hips tend to describe it in very recognizable ways:

The wish to “get it over with once” is completely understandable — and I take it seriously. My job is to be honest that, for almost everyone, staging gets you to the same finish line more safely and more comfortably.

From Dr. Harb: how I approach bilateral hip arthritis

When I evaluate a patient with arthritis in both hips, I start from “what's the safest, most effective plan for this person?” — and for the large majority, that answer is a staged approach. I'm a fellowship-trained hip and knee surgeon who performs minimally invasive anterior hip replacement with same-day recovery, and that's exactly what makes staging so practical: you recover fast from the first hip and we do the second a few weeks later.

If both hips are keeping you from the life you want, that's a conversation worth having. Learn more about hip replacement with Dr. Harb, the signs it may be time, and how long modern hip replacements last (more than 90% intact at 30 years) — then come see us when you're ready.