Enhanced Recovery and Early Functional Outcomes Following Simultaneous Bilateral Total Hip Arthroplasty: A Single-Surgeon Case Series

Simultaneous bilateral total hip arthroplasty (THA) remains controversial because of concerns regarding perioperative physiological stress, blood loss, and postoperative complications; however, advances in patient selection, perioperative optimisation, blood conservation, anaesthesia, and enhanced recovery have supported its use in appropriately selected patients. This prospective observational case series evaluated the perioperative, functional, and early radiological outcomes of simultaneous bilateral THA performed by a single experienced surgeon at a tertiary-care arthroplasty centre between January 2025 and April 2026. Sixteen consecutive patients underwent simultaneous bilateral THA following comprehensive medical and anaesthetic assessment and counselling regarding simultaneous and staged procedures. Demographic characteristics, operative time, estimated blood loss, postoperative haemoglobin change, transfusion requirements, time to mobilisation, hospital stay, Harris Hip Score (HHS), and radiological outcomes were assessed. A standardised perioperative pathway incorporating tranexamic acid, multimodal analgesia, thromboprophylaxis, and early mobilisation was used. The mean age was 44.8 ± 15.1 years, with 12 (75.0%) males and 4 (25.0%) females; 11 patients (68.8%) underwent THA for avascular necrosis and 5 (31.2%) for secondary osteoarthritis. The mean operative time was 103.9 ± 11.3 minutes, estimated blood loss was 307.8 ± 61.3 mL, and postoperative haemoglobin decrease was 1.45 ± 0.38 g/dL. One patient (6.3%) required one unit of allogeneic blood transfusion. Mean time to mobilisation was 1.2 ± 0.4 days and hospital stay was 5.1 ± 0.5 days. Mean HHS improved significantly from 43.4 ± 5.0 preoperatively to 89.1 ± 3.0 at a mean follow-up of 8.2 ± 2.1 months, representing a mean improvement of 45.6 points (95% CI, 41.4 - 49.8; p < 0.001), with all patients achieving good-to-excellent functional outcomes. Radiographs demonstrated satisfactory component positioning and stable fixation, with limb-length restoration within 5 mm in 15 patients (93.8%). No deep infection, dislocation, symptomatic venous thromboembolism, perioperative mortality, or revision surgery occurred during follow-up. In this small prospective case series of carefully selected patients, simultaneous bilateral THA was associated with substantial early functional improvement, early mobilisation, low transfusion requirements, and favourable short-term radiological outcomes, supporting its feasibility when appropriate patient selection, multidisciplinary perioperative optimisation, and experienced surgical care are available. Larger comparative studies with longer follow-up are required to establish optimal patient selection and the long-term durability and comparative safety of this approach.