Having Your Second Hip Replaced: Both Hips, One at a Time or Together

Having one hip replaced does not cause the other to wear out, but plenty of people do end up needing both, because the arthritis was never confined to one joint in the first place. My left hip has started talking to me. Not shouting, the way the right one did for two years before I finally had it replaced, but a familiar ache after a long day in the garden that I recognise far too well. So I did what I did the first time and went and learned what actually happens when the second hip comes up, and this is what I found, checked over by Ms Raman as ever.

Why the second hip so often follows

The thing to understand first is that osteoarthritis is not a local accident. It is a condition of joints in general, one of the leading causes of pain and lost function worldwide, and it commonly affects more than one joint in the same person ¹. So when someone has both hips replaced over a decade, the usual story is not that the first operation damaged the second side. It is that both hips were quietly wearing out on similar timescales, and one simply reached the end of its tether first.

That distinction matters because the fear I hear most often, and had myself, is that the new hip is somehow overloading the old one. It is a reasonable-sounding worry and it is largely the wrong model. What is genuinely true is smaller and more temporary: in the weeks after surgery you lean harder on the untreated leg, so if that hip is already arthritic it may well ache more than usual for a while. That is a real effect on symptoms, not a cause of the underlying wear. If you want the mechanics of what is actually happening inside the joint, I set it out in hip osteoarthritis.

One operation or two: staged and simultaneous

There are two ways to end up with two new hips, and the difference is worth knowing before you are asked about it.

Staged surgery means two separate operations, with a gap between them that might be a few months or a good many years. This is the more usual route, and it is what happens by default when one hip becomes unbearable well before the other. You recover from the first, live with the second for as long as it lets you, and go back when it stops letting you.

Simultaneous bilateral hip replacement means both hips done under one anaesthetic, in one session. It is offered by some surgeons in selected cases, and the appeal is obvious: one anaesthetic, one hospital admission, one recovery, one period off work, and no months of hobbling on an arthritic hip while the new one heals. The trade is that it is a bigger physiological event to put a body through in a single sitting, so it is generally reserved for people who are fit enough for it, whose hips are both badly affected, and who have serious support at home. There is no crutch-free good leg to lean on afterwards, and that shapes the first fortnight completely.

Which of these applies to you is not really a matter of preference. It is a judgement about your general health, your heart and lungs, your weight, your other conditions, and how much help you have at home, and it belongs with the surgeon who can examine you. What I would say is that it is a fair question to ask early rather than assuming staged is the only option on the table.

When to have the second one done

The trigger is the same as it was for the first, which is oddly reassuring. International guidance is consistent that joint replacement is for when the non-surgical measures, exercise, weight management, and pain relief, have stopped holding the line against your symptoms ². So the questions are the ones I asked myself before my right hip: is the pain controlled, am I sleeping, has my life quietly shrunk to fit around the joint, and are the things I have given up ones I want back. My notes on signs it is time for a hip replacement apply just as squarely to the second hip as to the first.

There is one extra consideration the second time. Your surgeon will generally want the first hip properly recovered before the second operation, because that side will have to do the supporting work during the next recovery. Full recovery of strength and confidence after a hip replacement runs to somewhere between six and twelve months, and structured rehabilitation is what carries you through it ³. Going into a second operation while the first side is still weak makes an already demanding fortnight harder than it needs to be.

The counter-argument, which I have heard from readers who left the second hip a long time, is that waiting has its own cost. A limp that has been running for years teaches your whole body compensations, and those get harder to unlearn the longer they run. There is no formula that balances those two things. It is a conversation, and it is yours.

Is the second one easier?

The operation is not easier. It is the same procedure, roughly one to two hours, the same one to three day hospital stay for most people, and the same risks: dislocation at about 1 to 2 in 100, highest in the early weeks, and deep infection at about 1 in 100, uncommon but serious. I have written the full list in hip replacement risks and complications and none of it gets smaller because you have done it before.

What changes is everything around the operation. You know the shape of the first week. You know that the second week has a low patch in it and that the low patch is not a sign of failure. You still own the raised toilet seat, the grabber, the long shoe horn, and the perching stool, so the preparation I laboured over in preparing for hip replacement surgery takes an afternoon rather than a month. You know which exercises on the sheet you actually did. And you have a strong hip on the other side, which is a completely different starting position from the first time, when both were bad.

Almost every reader of mine who has had both done says the same thing in different words: the second one frightened them less and went faster, even though nothing about the surgery had changed. Not everyone, though. A couple have told me the second was harder, usually because life around it was harder, and that is worth saying too so nobody feels they have failed a comparison.

What two new hips are worth

I asked Ms Raman whether it was worth having the second one when the first had gone so well, and her answer was that the question answers itself if the second hip is stopping you doing things. Hip replacement is one of the most effective operations in modern medicine for arthritis pain, around nine in ten people are satisfied with the result, and the implants last: typically fifteen to twenty-five years, with around 90 to 95 percent still in place at ten years and roughly six to eight in ten still working at twenty-five ⁴. Standard practice is that both operations are planned, consented, and followed up with the same care, not that a second one is treated as a lesser event ⁵.

My own left hip is not there yet. It aches after gardening, it does not wake me, and I can still walk as far as I want to. When it starts taking things from me the way the right one did, I will go back, and this time I will not spend two years pretending it is fine first. That, if I am honest, is the only real lesson I have from the first hip that applies to the second: I know now what leaving it too long costs, and the second time I will not pay it.

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This is general information from my own experience and reading, checked for accuracy, and not medical advice. Whether your other hip needs replacing, and whether one operation or two is right for you, depends on your joints, your health, and your circumstances, so please discuss it with a qualified clinician who can examine you.