Bilateral Hip Replacement in Turkey

Bilateral hip replacement is a surgical procedure in which the damaged parts of both hip joints are removed and replaced with artificial joints. It is performed either in a single surgical session under one anesthetic, or in two stages separated by a recovery period.

Hip replacement is considered when hip pain interferes with daily activities and non-surgical treatments are not enough, such as medication, physical therapy, and using a cane or walker. Your eligibility for the procedure is determined by the surgeon after examination and imaging, and it is not suitable for every patient.

• Non-surgical treatment is tried first in many cases, and the surgeon determines eligibility after examination and imaging.
• Bilateral replacement takes three forms: a single session, two staged operations spaced apart, or two consecutive operations during the same stay. The last form is the least supported by evidence.
• Patients who undergo single-session surgery in studies are often younger and healthier, so direct comparison is not appropriate.
• Some complications showed a relatively lower tendency with single-session surgery, and others a relatively higher one. There is no reliable estimate of the absolute risk specifically for bilateral replacement.
• An artificial joint may need further surgery over time, and in bilateral replacement there are two artificial joints to monitor.
• The timing of travel after surgery is decided by the surgical team based on the wound, mobility, clot risk, and the length of the journey.

What Is Bilateral Hip Replacement

Damage affects both hips in some patients, and both joints need replacing. Studies describe two established approaches:

1. Single session. Both joints are replaced in one stay under one anesthetic, with the two hips operated on one after the other in the same session.
2. Two spaced stages. Two separate operations are performed, with two anesthetics and two hospital stays. The interval between them in studies ranged from weeks to years, and there is no agreed optimal interval.

There is also a third form that is sometimes offered to patients traveling from abroad: two consecutive operations during the same visit. We address it cautiously in a separate section because the evidence for it is limited.

Single Session or Two Stages: What Do the Studies Say?

Strength of the Evidence

• A systematic review covered thirty-eight studies, only two of which were randomized trials, with the rest being observational studies. Its authors concluded that stronger trials are needed.
• Another review covered thirteen studies, found that most carried a high risk of bias, noted that the definitions of staged surgery and the measurement of outcomes varied widely, and described the quality of the evidence as low.
• A recent review covered twenty observational studies and acknowledged bias in patient selection and publication bias.

What the Studies Broadly Agree On

• The reviews and the large Swedish registry found no clear difference in early mortality between the two approaches. However, the absence of a statistically significant difference does not necessarily mean the two approaches are equivalent.
• In pooled analyses, there was a relative tendency toward a shorter total hospital stay and lower cost with single-session surgery. However, results vary with the care system and the method of calculation. In a multicenter Chinese study, total hospital cost did not differ between the two approaches.

What Is Still Debated

• Blood clots: The 2022 review found a relative tendency toward fewer leg-vein clots with single-session surgery, with a relative increase in clots traveling to the lungs.
• Fracture around the artificial joint: A relative increase appeared with single-session surgery in the same review, but the statistical strength of the result is weak.
• Blood transfusion: It tended to be clearly higher with single-session surgery in several studies, including a Chinese study. For this reason, the literature discusses blood-management measures to reduce the need for transfusion.
• Revision surgery: There is no agreement. In the Swedish registry, the risk before accounting for differences between patients was slightly higher with single-session surgery, and the difference disappeared once those differences were accounted for. The 2022 review showed no difference. The 2026 review leaned in favor of single-session surgery, with low confidence in the result.
• Function and pain: The differences are small. The authors of the 2022 review judged the functional difference not clinically important. The 2026 review pointed to a preference for single-session surgery, with moderate confidence regarding function.
• Discharge destination after hospital: In a small number of studies, discharge directly home was less common with single-session surgery, meaning some patients needed a rehabilitation facility.
• Deep infection and dislocation: The 2022 review showed no clear difference between the two approaches.

Why Can’t We Be Certain?

1. Most studies are observational, so patients were not randomly assigned to the two approaches. Single-session patients were on average younger and healthier, and part of the good results may be due to this selection rather than the approach itself.
2. The word “higher” in the studies describes a relative risk between two groups. The absolute risk of these complications is generally low after hip replacement, as general medical sources describe it, and there is no reliable estimate of it for bilateral replacement specifically, so the team estimates it according to your condition.
3. Results vary by country, health system, and protocols for blood management and clot prevention.

What About Two Consecutive Operations During the Same Stay?

Some patients traveling from abroad may be offered the first hip and then the second a few days later during the same visit. This differs from two stages spaced weeks or months apart.

• The evidence for it is of low quality. A systematic review noted an increased risk of complications when staged surgery was performed during the same stay, and recommended avoiding it.
• There is no scientifically established optimal interval between two stages.
• This option should not be viewed as a way to shorten the time spent traveling.
• If it is offered to you, ask the surgical team for a written medical explanation: Why this interval? What are the conditions for performing the second operation? And what if recovery after the first is not sufficient?

Who Is the Right Candidate for Each Option?

There is no single rule, and no fixed limits for age or anything else. What the studies indicate:

Factors that raise risk in general and are taken into account when choosing the approach:

• Advanced age, rheumatoid arthritis, and poor general health before anesthesia. These were associated with higher early mortality among people who had bilateral replacement in the Swedish registry, under both approaches, and its authors saw them as something to take into account when choosing.

What studies have relied on when considering single-session surgery:

• A systematic review supported single-session surgery for selected patients who were younger, healthier, and free of cardiovascular disease.
• Selection criteria differ from one study to another, so they should not be treated as a fixed rule.
• A recent review pointed to a study that linked comparable outcomes to surgery performed by a surgeon who handles a high volume of cases.

Two spaced stages is a well-established option for those who do not meet these conditions. In both cases the decision is individual and is made by the surgical team after a comprehensive evaluation.

What Do Evaluation and Preparation Before Surgery Involve?

General medical sources describe the following before hip replacement:

• Reviewing your medical history and medications, and determining what should be stopped or continued before surgery.
• Examining the hip, blood tests and imaging, and sometimes CT or MRI and an electrocardiogram when needed.
• Stopping smoking and nicotine use before surgery, because it impairs healing.

In bilateral replacement, these points carry more weight:

• Assessing the heart, lungs, and general health before anesthesia.
• A blood-management plan that defines how the need for transfusion will be reduced.
• The type of anesthesia (spinal or general), according to your condition and the anesthesiologist’s judgment.
• A clot-prevention plan, a rehabilitation plan, and having a companion with you.

What Are the Risks in Bilateral Replacement?

The general risks of hip replacement, as described by major medical sources, include blood clots, infection, fracture, dislocation, a difference in leg length, nerve injury, and loosening of the artificial joint. They are rare in most cases.

The following are discussed in particular for bilateral replacement:

• Blood clots: These sometimes form in the leg veins after surgery and may travel to the lungs (pulmonary embolism). The risk is reduced through early movement, leg compression methods, and blood-thinning medication according to the team’s plan. Prevention methods and their duration vary from one center to another and from one patient to another, so ask the team about your plan and who will follow it after you return home. Signs that call for informing the doctor immediately:
  • Leg or calf pain not related to the incision.
  • Redness or tenderness in the leg.
  • New or severe swelling in the thigh, leg, or ankle.
  • Sudden shortness of breath or chest pain, which require emergency care immediately.
• Fracture around the artificial joint: It remains rare, but some studies noted a relative tendency toward it with single-session surgery.
• Blood loss and transfusion: It tended to be higher with single-session surgery, so a plan to manage it is prepared before surgery.
• Infection: Its signs include fever and chills, increased redness and swelling or discharge from the wound, or new or increasing pain. Inform the team immediately if any of these appear.
• Need for later surgery: The parts of the artificial joint may wear or loosen over time, especially in people who have the operation at a younger age and with higher activity. Some may need a second replacement operation. In bilateral replacement, there are two artificial joints that need to be monitored.

What Does Recovery and Rehabilitation Look Like?

There are no established rehabilitation guidelines specific to bilateral replacement in the general sources this article relies on. What follows is taken from guidance on hip replacement in general, and the timelines may differ in bilateral replacement:

• Physical therapy begins early, and early movement and walking with an assistive device (a crutch or walker) are encouraged.
• Your doctor decides when you can put your full weight on the leg. This may be immediate or delayed by weeks, depending on the type of surgery.
• The prescribed exercises continue for weeks to months, with gradual improvement.
• Swelling may last weeks and sometimes months. Any new or severe swelling may be a sign of a clot, so inform your doctor.
• Returning to work takes weeks to months depending on the nature of your job.
• You will receive instructions for protecting the joint that vary with the surgical technique, so follow what your team specifies.

Some single-session patients needed a rehabilitation facility after the hospital. So ask the team: How will getting around work in the first days when both hips are freshly operated on? And who will help you?

Length of Stay in the Hospital and Afterward Before Travel

In the hospital: The reviews show a relative tendency toward a shorter total number of days with single-session surgery. But these results come from different health systems, and there is no reliable reference that defines the length of stay in Turkey. For this reason, we do not state a number of days, as the duration varies with the case and the decision of the medical team.

After discharge and before travel: The American Academy of Orthopaedic Surgeons (AAOS) advises consulting the doctor before flying, because changes in pressure and lack of movement may cause leg swelling. In the evidence:

• The authors of an observational study noted that evidence on air travel after joint replacement is limited.
• That single-center study found an association between short flights around the time of surgery and a relative increase in venous clots.
• There is no agreed number of days, and no data specific to bilateral replacement.

The decision rests with the surgical team. It is usually based on the condition of the wound, your ability to move, your clot risk, the length of the flight, and the preventive measures taken during it.

How Do You Prepare Your Place of Stay After Discharge?

Medical sources offer advice on preparing a recovery space. In principle, it applies to where you stay after leaving the hospital:

• Arrange the furniture to allow movement with an assistive device, and avoid stairs as much as possible.
• Keep frequently used items (phone, medications, water) within reach without bending.
• Remove rugs that may cause slipping.
• Ask your team about the equipment you may need in the bathroom and when sitting.
• Ask whether your accommodation has an elevator and step-free entrances, and about transportation between the accommodation and the hospital.
• Arrange for a companion, as sources indicate that the need for help may extend from days to weeks.

Questions to Ask the Surgeon Before the Decision

Ask the surgical team these questions, and request written answers where possible:

• Am I a candidate for a single session, or do you recommend two stages? And what are the reasons in my case?
• How many bilateral cases does the team perform, and how are their outcomes tracked?
• What is the blood-management and clot-prevention plan, how long does it last, and how do I follow it when I return to my country?
• How will the anesthesia be done?
• When can I travel in my specific case? And under what conditions?
• Who will follow up on my wound after I travel, whom do I contact in an emergency, and how are complications managed after I return?
• What is the likelihood that I will need later surgery, and how are the two artificial joints monitored?
• What does the offer include and what does it not include?
• Will I receive a detailed medical report and an ID card for the implanted joint?

When comparing centers, see the page on orthopedic and joint surgery hospitals in Turkey for points to consider.

What Are the Cost Factors for Bilateral Hip Replacement in Turkey?

O9 Medical estimates the cost of bilateral hip replacement in Turkey at an initial indicative range of 16,000 to 20,000 US dollars, which is a non-binding estimate. The final price is determined after the case is evaluated, depending on the type of artificial joint, the complexity of the case, the method of the procedure (single session or two stages), and the length of stay.

The main factors affecting cost:

• The type of artificial joint and its materials
• The surgical technique and the complexity of the case
• Single session or two stages
• Length of hospital stay and type of care
• Tests before the operation
• Blood-management plan and medications
• Physical therapy and rehabilitation
• Follow-up and imaging after the operation
• The patient’s and companion’s accommodation outside the hospital