We reviewed retrospectively 26 replacement arthroplasties performed as bilateral simultaneous procedures in 12 patients at an osteopathic community hospital during a 52-month period. One patient had two bilateral operations. Surgical time, estimated blood loss, units of blood transfused, perioperative morbidity, number of days hospitalized, and hospital costs were compared with data from randomly selected patients who underwent unilateral procedures during the same time period. The bilateral group had an average length of stay of 12 days (vs 10.3 days), an average surgical time of 2 hours 37 minutes (vs 1 hour 55 minutes), an average blood loss of 419 mL (vs 277 mL), and average hospital costs of $12,315 (vs $10,272) in comparison with the unilateral group. Perioperative morbidity was similar for both groups. Our findings indicate that bilateral simultaneous procedures offer a reasonable approach and a savings of time and money for selected patients who require multiple joint replacements for improved functional status.