Simultaneous bilateral hip resurfacing means both hips are resurfaced in the same operation, one after the other, under a single anaesthetic. Each hip receives the same bone-preserving implant it would in a single-hip operation. The difference is not the surgery itself but the fact that you go through it once.
Hip arthritis is often a two-sided condition. Many patients who come to clinic with a painful hip already have clear wear in the other, and for some the second hip is only a year or two behind the first. When both are already limiting daily life, the question is not whether the second hip will need attention but when, and in what order.
There are two ways to deal with it. Staged surgery treats one hip, lets you recover, then treats the other months later. Simultaneous surgery treats both in one sitting. The operation on each hip is identical to the one described on our procedure page: the worn surface of the ball is reshaped and capped, and the socket is lined with a matching bearing. Mr Hussain resurfaces the more painful hip first, then repositions you and resurfaces the second.
The whole operation takes two to three hours, roughly double a single hip. You are asleep throughout under a general anaesthetic, with a longer-acting spinal anaesthetic alongside it so that both hips are numb for the first hours after you wake. The spinal used for a single hip is chosen to wear off conveniently; for two hips it is chosen to last.
One operation means one anaesthetic, one hospital stay, one course of recovery and one period away from work or sport. It also removes a problem staged patients know well: rehabilitating a new hip while the untreated one still hurts. With both done together, nothing is holding the recovery back on either side.
The practical case is easy to see. Two separate operations mean two admissions, two sets of pre-operative tests, two spells on crutches and, for most working people, two blocks of leave. Done together, those halve.
The less obvious benefit is in the rehabilitation itself. Patients who have one hip resurfaced while the other is still painful often find the untreated side limits what they can do with the new one. They favour the painful hip, walk unevenly, and the new joint learns a lopsided pattern. With both hips treated, physiotherapy starts from a level base and the gait that returns is symmetrical from the outset.
There is a further reason that matters to patients who travel to Birmingham from a distance: one journey instead of two. That is covered in its own section below.
It suits patients whose hips are both painful enough to need surgery now, who are otherwise fit, who have good bone quality on both sides, and who have someone at home for the first fortnight. There is no fixed age or weight cut-off; each patient is assessed individually against the usual criteria for resurfacing and for a longer anaesthetic.
The patient this operation is designed for looks something like this.
Not one bad hip and one that twinges. If the second hip would not need surgery on its own within a year or so, there is little to gain by treating it now.
No significant heart or lung disease, and the stamina to tolerate a two-to-three-hour operation. Mr Hussain assesses this with the anaesthetic team before anything is booked.
The same requirement as any resurfacing: a femoral head and neck strong enough to take the implant. One poor-quality hip rules out resurfacing on that side, and therefore rules out bilateral resurfacing.
Two hips mean more blood loss than one. Starting with a healthy haemoglobin level makes a transfusion much less likely.
For the first two weeks you will have no "good leg" to lean on. Someone needs to be around.
The first fortnight is harder than after a single hip. Patients who do well are the ones who expected that.
Most patients who meet these criteria are active people in their forties, fifties or early sixties who have been putting up with two bad hips and want one decisive fix. Many are already candidates for resurfacing in general, as set out on the candidacy page; the bilateral decision is an extra layer on top of that assessment, not a different one.
Bilateral resurfacing is best avoided when one hip is only mildly symptomatic, when heart, lung or kidney disease makes a long anaesthetic unwise, when anaemia or poor bone quality raises the risk on either side, or when there is no support at home. In those cases a staged approach is safer and usually just as good.
The reasons to say no fall into three groups.
A longer operation puts more demand on the heart and lungs, and the blood loss is greater. Patients with significant cardiac or respiratory disease, poorly controlled diabetes, kidney impairment or a history of blood clots are usually better served by two shorter operations with time to recover between them. Significant obesity makes both the surgery and the recovery harder on two sides at once, and is a common reason to stage.
If one hip is clearly worse and the other could reasonably wait a year or more, there is no advantage in treating it early. Equally, if one hip has poor bone, a large cyst or avascular necrosis that makes resurfacing uncertain on that side, it is better to deal with the straightforward hip first and reassess the other with a clear head.
Living alone, having no one to help for the first fortnight, or feeling anxious about a demanding early recovery are all good reasons to stage. None of these is a criticism; the operation simply asks more of you at home than a single hip does.
Takeaway Mr Hussain discusses each of these at consultation. If the answer is to stage, the second hip is usually planned once the first has settled, typically a few months later.
The first two weeks are the hard part. With both hips operated on there is no stronger leg to take the weight, so standing, turning in bed, stairs and getting in and out of a car all take more effort and more help. The operation is longer, blood loss is greater, and the hospital stay is usually a night or two longer.
Patients deserve a plain account of this, so here it is.
After a single hip you push up from the untreated side without thinking. After two, both legs are sore and both are weaker. Sitting down, standing up, turning over in bed and getting on and off the toilet are all slower and need technique. The physiotherapists teach it before you leave, and most patients have it worked out within a week.
You will manage them before going home, but they are the hardest thing in the first fortnight. If your bedroom and bathroom are upstairs, think in advance about whether you can live downstairs for a week or two.
Two to three hours under anaesthetic rather than one to one-and-a-half. For a fit patient this is well within safe limits, but it is why fitness is assessed so carefully beforehand.
Roughly double a single hip. A blood transfusion is uncommon but more likely than after one hip, which is why your blood count is checked and, if needed, improved before surgery.
Any hip surgery carries a risk of blood clots in the leg or lung. Operating on both sides, with a longer time on the table, raises it slightly. You will have blood-thinning medication and compression stockings as standard, and early walking matters more than ever.
Pain is well controlled, but it is on two sides rather than one, and you cannot favour one leg over the other. Most patients describe the first few days as tiring rather than agonising.
Two to four nights rather than one to two, so the team can see you safely managing stairs and transfers before you go home.
If one side is slower to settle than the other, there is no fully recovered leg to compensate with. In practice the two hips tend to recover at a similar pace.
Worth knowing By the third week the picture changes. Patients who were well prepared for the first fortnight generally report that from then on the recovery feels much like a single hip, except that it is finished.
You will be up with the physiotherapists on the day of surgery or the next morning, weight-bearing on both legs. Expect two crutches for three to four weeks, one crutch for a further week or two, and walking unaided at around six weeks. From there the timeline matches a single hip.
The milestones below are a guide. Everyone's recovery is different, and Mr Hussain and the physiotherapy team will adjust the plan to how you are doing.
Our full recovery guide covers each stage in more detail; the only real difference after bilateral surgery is the first two weeks.
Yes. Patients who travel from elsewhere in the UK, from Ireland or from abroad often find that one operation makes the whole undertaking manageable. One journey, one stay near the hospital, one set of follow-up appointments. Provided you are fit for bilateral surgery, distance is a legitimate reason to choose it.
Resurfacing is a specialist operation and many patients travel a long way for it. For someone coming from Scotland, the south-west, Northern Ireland or overseas, two staged operations mean two return trips, two periods away from home, and twice the arrangements for accommodation and companions.
Bilateral surgery collapses that into one visit. The pre-operative assessment, the operation, the hospital stay and the early physiotherapy all happen in a single stretch, and routine follow-up can often be combined with your return journey or arranged remotely with your local physiotherapist.
This is not a reason to have bilateral surgery if you are not a good candidate for it; the medical criteria come first. But where you are suitable, Mr Hussain regards distance as a perfectly reasonable factor in the decision, and will plan the admission with your travel in mind. Our international patients page explains how enquiries from outside the UK are handled.
For many patients, yes. Two separate operations, usually a few months apart, give the body time to recover between them and let you lean on a healed hip while the second one settles. The outcome for each hip is the same either way; the difference is how you get there.
Staged surgery is the default for anyone who is not a clear candidate for bilateral, and it is a perfectly good choice for those who are. The first hip is resurfaced, you recover over six to twelve weeks, and the second is planned once you are walking well and keen to deal with it. Some patients find that once the worst hip is sorted, the other becomes tolerable for longer than expected and the second operation can wait.
The interval between staged operations is flexible. Three to six months is typical, long enough for the first hip to be strong, short enough that the untreated side does not drag the recovery for too long.
Neither route changes the long-term result for the implant. The choice is about safety, practicality and what suits your life, and it is made together at consultation.
Bring recent X-rays of both hips and you will leave the consultation with a clear recommendation: bilateral, staged, or neither.
Book a ConsultationBilateral hip resurfacing is quoted individually, because the implant choice, the hospital and the length of stay vary from patient to patient. As a guide, a single hip is a fixed £12,250 for the Adept implant and £13,450 for ReCerf at the Royal Orthopaedic Hospital. Insurers assess bilateral surgery case by case.
A bilateral package is not simply twice the single-hip price. The anaesthetic, theatre time and hospital stay are shared, so the second hip adds less than a full second fee; but the implants are two, and the stay is longer. For that reason Mr Hussain's team provides an individual written quotation after consultation, once the implant and hospital are agreed.
The consultation fee is £250 and includes a review of your X-rays and a clear recommendation on whether bilateral or staged surgery is right for you. Insured patients should ask their insurer about preauthorisation for bilateral surgery specifically; most major insurers cover it when the clinical case is clear. Our fees page and insurance guide have the detail.
Yes. Simultaneous bilateral hip resurfacing is an established approach for fit patients whose hips are both painful enough to need surgery. Each hip is resurfaced exactly as it would be on its own; the operation simply continues to the second side under the same anaesthetic.
Two to three hours, roughly double a single hip. You are under a general anaesthetic throughout, with a longer-acting spinal anaesthetic alongside it for pain control in the first hours after surgery.
Usually two to four nights, a night or two longer than for a single hip. You go home once you can manage stairs and get in and out of bed and a chair safely on your own.
Yes. You will be up with the physiotherapists on the day of surgery or the next morning, taking full weight through both legs with a frame or crutches. Walking is encouraged from the start; it is the best protection against blood clots and the quickest route to recovery.
Slightly. The operation is longer, blood loss is greater and the risk of blood clots is a little higher. For a fit patient with no significant heart, lung or kidney disease these risks remain low, which is why fitness is assessed carefully before bilateral surgery is offered. For patients who are less fit, staging is safer.
Yes, provided you are a suitable candidate. One operation means one journey and one stay, which many travelling patients find makes the whole process manageable. The admission is planned with your travel in mind, and follow-up can often be arranged with a physiotherapist near home.
Mr Hussain sees private patients at the Royal Orthopaedic Hospital, Priory Hospital Edgbaston and The Harborne Hospital. Bring recent X-rays of both hips and you will leave the consultation with a clear recommendation: bilateral, staged, or neither.
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