Bilateral total hip arthroplasty: Definition, Uses, and Clinical Overview

Posted on February 27, 2026 | by drhip

Bilateral total hip arthroplasty Introduction (What it is)

Bilateral total hip arthroplasty is a surgery that replaces both hip joints with artificial components.
“Bilateral” means both sides, and “total hip arthroplasty” means replacing the ball-and-socket joint.
It is commonly used for advanced arthritis or joint damage affecting both hips.
It may be done in one operation or in two separate operations, depending on the case.

Why Bilateral total hip arthroplasty used (Purpose / benefits)

Bilateral total hip arthroplasty is used to treat pain and disability caused by severe disease or damage in both hip joints. The hip is a major weight-bearing joint, and when the joint surfaces are badly worn or deformed, everyday movements—standing, walking, climbing stairs, dressing, and sleeping—can become difficult.

At a general level, the goal is to:

Relieve joint pain that comes from damaged cartilage and underlying bone rubbing together.
Restore function and mobility by creating a smoother, more stable joint surface.
Improve alignment and mechanics when deformity, stiffness, or leg-length differences are present (the extent of correction varies by clinician and case).
Address bilateral symptoms efficiently when both hips are limiting quality of life.

When both hips are affected, treating only one side may still leave a person significantly limited by the other hip. Bilateral replacement is one way clinicians may address the overall problem of “two painful hips” in a coordinated plan, while balancing surgical complexity, medical risk, and rehabilitation needs.

Indications (When orthopedic clinicians use it)

Orthopedic clinicians may consider Bilateral total hip arthroplasty in situations such as:

Advanced osteoarthritis in both hips with persistent pain and functional limitation
Inflammatory arthritis affecting both hips (for example, rheumatoid arthritis), when joint damage is severe
Hip joint collapse or deformity on both sides (for example, advanced avascular necrosis), depending on extent and staging
Post-traumatic arthritis affecting both hips (less common, varies by history)
Bilateral hip dysplasia with end-stage degenerative changes
Severe stiffness or loss of hip motion in both hips that limits daily activities
Failure of non-surgical options to provide acceptable symptom control (varies by clinician and case)

Contraindications / when it’s NOT ideal

Bilateral total hip arthroplasty may be not suitable or may be deferred in circumstances such as:

Active infection anywhere in the body, or suspected infection in/around the hip region
Significant uncontrolled medical conditions that increase anesthesia or surgical risk (for example, unstable heart or lung disease)
Poor overall physiologic reserve where a longer operation or higher rehabilitation demands may be poorly tolerated (varies by clinician and case)
Severe osteoporosis or poor bone quality where certain fixation strategies may be less suitable (implant choice and approach vary by surgeon, bone quality, and manufacturer)
Neuromuscular conditions or severe balance disorders that increase instability or fall risk, potentially affecting implant stability and rehab
Inability to participate in postoperative rehabilitation or follow-up due to cognitive, social, or access barriers (planning and support needs vary)
Situations where a staged approach (one hip at a time) may be safer than doing both hips together (decision varies by clinician and case)

“Contraindication” does not always mean “never.” In practice, clinicians weigh risks and benefits and may modify timing, technique, implant selection, or perioperative planning.

How it works (Mechanism / physiology)

Bilateral total hip arthroplasty works through biomechanical replacement of the diseased hip joints rather than healing damaged cartilage. Hip cartilage has limited natural ability to regenerate once severely worn. In end-stage arthritis, pain often comes from inflamed joint lining, bone-on-bone contact, and mechanical stress from deformity and stiffness.

Relevant hip anatomy (in simple terms)

The hip is a ball-and-socket joint:

The femoral head is the “ball” at the top of the thighbone (femur).
The acetabulum is the “socket” in the pelvis.
Articular cartilage covers both surfaces to allow smooth motion.
The labrum is a rim of cartilage around the socket that helps with stability.
Capsule and ligaments stabilize the joint.
Surrounding muscles (gluteal muscles, hip flexors, rotators) control motion and gait.

What the replacement changes mechanically

A total hip replacement typically includes:

A socket component placed in the pelvis (often a metal shell with a liner).
A stem placed in the femur.
A ball (head) that fits on the stem and moves within the socket liner.

By replacing the worn surfaces, the procedure aims to:

Reduce friction and abnormal contact forces
Restore a functional range of motion
Improve load transfer through the pelvis and femur
Improve stability, depending on implant design, component position, soft-tissue tension, and patient factors

Onset, duration, and reversibility (as applicable)

Onset of benefit: Pain and function often improve progressively with healing and rehabilitation; the pace varies by clinician and case.
Duration: Hip implants are designed to last many years, but longevity varies by patient factors (activity level, bone quality), implant materials, and manufacturer.
Reversibility: Joint replacement is generally considered not reversible in the way a medication is. Revision surgery is possible if problems occur, but it is a different and typically more complex operation.

Bilateral total hip arthroplasty Procedure overview (How it’s applied)

Bilateral total hip arthroplasty is a surgical intervention. The exact workflow varies by institution and surgeon, but a general sequence includes:

Evaluation / exam – History of symptoms (pain location, stiffness, walking tolerance, sleep disruption) – Physical exam (range of motion, gait, leg lengths, strength) – Imaging, commonly X-rays; additional imaging may be used in selected cases – Review of non-surgical treatments already tried and overall health status
Preparation – Medical optimization and perioperative planning (medications, anemia risk, comorbidities) – Discussion of doing both hips in one setting versus staging them – Planning for home support, mobility aids, and rehabilitation needs
Intervention (surgery) – Anesthesia selection (varies by clinician and case) – Surgical exposure of each hip joint – Removal of damaged joint surfaces and preparation of bone – Placement of the acetabular and femoral components – Assessment of stability, leg length, and range of motion during the operation
Immediate checks – Postoperative monitoring, pain control, and early mobilization as appropriate – Imaging may be obtained to confirm component position (practice varies)
Follow-up – Wound checks and monitoring for complications – Progressive rehabilitation focused on gait, strength, and function – Longer-term follow-up may assess implant function and symptoms over time

This is an overview, not a step-by-step guide. Specific surgical techniques and protocols vary substantially by clinician and case.

Types / variations

Bilateral total hip arthroplasty can be described in several clinically relevant ways:

Timing: simultaneous vs staged

Simultaneous bilateral: both hips are replaced during one anesthetic event.
Staged bilateral: each hip is replaced in a separate operation, separated by weeks to months (timing varies by clinician and case).

Surgical approach (path to the hip joint)

Common categories include:

Posterior approach
Lateral (anterolateral) approach
Direct anterior approach

Approaches differ in muscle/soft-tissue handling and surgeon preference; suitability varies by anatomy, diagnosis, and surgeon experience.

Fixation method (how components attach to bone)

Cementless (press-fit) fixation: relies on bone growth onto/into the implant surface over time.
Cemented fixation: uses bone cement to secure components.
Hybrid approaches: one component cemented, the other cementless.

Choice varies by bone quality, age, anatomy, implant system, and surgeon preference.

Bearing surfaces (materials that slide together)

Common pairings include:

Metal head with polyethylene liner (polyethylene type varies by manufacturer)
Ceramic head with polyethylene liner
Ceramic-on-ceramic (used in selected cases; material tradeoffs vary)

Material selection aims to balance wear characteristics, stability, and risk profile; performance varies by material and manufacturer.

Technology and technique variations

Conventional instrumentation vs computer navigation or robot-assisted systems (availability and use vary)
Standard vs “muscle-sparing” or “minimally invasive” descriptors (definitions vary by clinician and case)

Pros and cons

Pros:

Can address both painful hips in a coordinated treatment plan
Potential for improved overall mobility compared with treating only one side when both are severely symptomatic
May reduce the period of living with one untreated hip (relevant when both are limiting)
Can improve gait mechanics once both joints are functioning better (rehabilitation-dependent)
Replaces severely damaged joint surfaces when cartilage repair is not feasible in end-stage disease
For some patients, may consolidate planning, time away from work, and rehabilitation into a single overall course (varies by clinician and case)

Cons:

Major surgery with risks such as infection, bleeding, blood clots, nerve injury, dislocation, fracture, or medical complications (risk varies by clinician and case)
Rehabilitation can be more demanding when both hips are healing at once, especially early on
May involve longer operative time and physiologic stress than unilateral surgery (depends on simultaneous vs staged)
Leg length and stability balancing can be more complex across two sides (managed intraoperatively; outcomes vary)
Implant wear or loosening can occur over time; some patients require revision surgery in the long term (timing varies)
Pain control, mobility, and home support needs may be greater during early recovery

Aftercare & longevity

Aftercare and longevity are influenced by multiple interacting factors rather than a single “rule.” In general, outcomes depend on the condition of the hips before surgery, overall health, implant selection, surgical technique, and the quality and consistency of rehabilitation.

Key factors that commonly affect recovery and longer-term function include:

Baseline joint condition and deformity: Severe stiffness, contractures, or significant deformity may make recovery more complex.
Muscle strength and gait habits: Weak hip abductors (side muscles) and long-standing limping patterns can take time to retrain.
Rehabilitation participation: Therapy and home exercises are often used to restore walking pattern, balance, and strength; the exact plan varies.
Weight-bearing status and precautions: Some patients are allowed to bear weight early, while others have restrictions based on bone quality, fixation, or intraoperative findings (varies by clinician and case).
Comorbidities: Diabetes, vascular disease, inflammatory conditions, smoking status, and other health factors can influence wound healing and complication risk.
Implant materials and positioning: Wear characteristics and stability depend on the bearing surfaces and component position; longevity varies by material and manufacturer.
Activity profile: Impact loading, repetitive high-demand activity, and falls can influence wear, fracture risk, and implant performance over time.

Most follow-up schedules include early postoperative checks and periodic assessments thereafter, but frequency and duration of follow-up vary by clinician and case.

Alternatives / comparisons

Bilateral total hip arthroplasty is one option within a spectrum of hip care. Alternatives may be considered depending on diagnosis, severity, age, imaging findings, and response to prior treatments.

Non-surgical management (often tried first in many cases)

Activity modification and pacing: May reduce symptom flares but does not reverse structural arthritis.
Physical therapy: Can improve strength, flexibility, balance, and walking mechanics; may help symptoms even when arthritis is present.
Medications: Options include anti-inflammatory and analgesic medications; benefit and tolerability vary widely.
Assistive devices: Can reduce load on the hip and improve safety for some people.

These approaches are typically aimed at symptom control and function rather than joint surface restoration.

Injections and other procedures

Corticosteroid injection: May provide temporary pain relief for some patients; effects vary and are time-limited.
Other injections (for example, hyaluronic acid or biologic injections): Use and evidence vary by region, indication, and clinician; benefits are not uniform across diagnoses.

Joint-preserving hip surgery (selected cases)

Hip arthroscopy (labral repair, femoroacetabular impingement correction): Often used for mechanical problems earlier in the disease course, not end-stage arthritis.
Osteotomy or reconstructive procedures: Used in selected deformities; patient selection is specific.

Unilateral total hip arthroplasty (one side)

If only one hip is replaced first, it may reduce overall surgical stress compared with replacing both at once. However, the untreated hip may still limit walking and recovery. Whether unilateral, staged bilateral, or simultaneous bilateral is preferred varies by clinician and case.

Bilateral total hip arthroplasty Common questions (FAQ)

Q: Is Bilateral total hip arthroplasty the same as “double hip replacement”?
Yes. “Double hip replacement” is a common non-medical phrase for replacing both hip joints. Clinically, it is described as bilateral total hip arthroplasty, done either simultaneously or as staged operations.

Q: How painful is recovery after both hips are replaced?
Pain levels vary widely and depend on factors such as prior pain sensitivity, surgical approach, and rehabilitation plan. Many patients describe a transition from deep arthritic pain to postoperative soreness that changes week by week. Pain control strategies differ by clinician and case.

Q: Will both hips be replaced in the same surgery or at different times?
Both options are used. Some patients have simultaneous bilateral replacement, while others have staged surgeries separated by a recovery interval. The decision depends on overall health, anesthesia risk, home support, and surgeon preference (varies by clinician and case).

Q: How long do hip replacements last?
Hip implants are designed for long-term use, but longevity varies. Factors include activity level, body size, bone quality, implant positioning, and bearing materials. Longevity also varies by material and manufacturer.

Q: Is Bilateral total hip arthroplasty safe?
It is a commonly performed orthopedic operation, but it is still major surgery with meaningful risks. Safety depends on patient-specific medical factors, surgical planning, and postoperative care. Risk profiles differ between simultaneous and staged approaches, and vary by clinician and case.

Q: When can someone drive after bilateral hip replacement?
Driving depends on safe reaction time, comfort sitting, and whether a person is still using sedating pain medications. Side of surgery and vehicle type can also matter. Clearance timing varies by clinician and case.

Q: When can someone return to work after bilateral hip replacement?
Return-to-work timing depends on job demands, commute, and recovery progress. Desk-based work may be possible earlier than physically demanding work, but timelines vary substantially. Many clinicians tailor recommendations to function and safety rather than a fixed date.

Q: Will I be able to put full weight on my legs right away?
Some patients are allowed to bear weight early, while others have temporary restrictions based on fixation type, bone quality, or intraoperative findings. Because bilateral surgery involves both sides, mobility planning is especially important. Weight-bearing instructions vary by clinician and case.

Q: What are common complications people worry about?
Commonly discussed risks include infection, blood clots, dislocation, leg-length difference, fracture, nerve injury, and implant loosening or wear over time. Not everyone experiences complications, and risk depends on health status and surgical details. Your clinician typically reviews risks in the context of your specific situation.

Q: Does doing both hips at once make rehabilitation harder?
It can, particularly in the first phase when both legs are recovering simultaneously. On the other hand, some people prefer a single overall rehabilitation period rather than recovering twice. Which is “better” depends on medical risk, support at home, and functional goals (varies by clinician and case).