This retrospective cohort study aimed to compare the total hospital cost, length of stay (LOS), and incidence of complications between simultaneous bilateral total hip arthroplasty (simBTHA) and staged bilateral total hip arthroplasty (staBTHA).We identified 256 patients who underwent staBTHA and matched them to a control group of 256 patients who underwent simBTHA from 2013 to 2016. Patients' demographics, total hospital costs, complication rates, and LOS were recorded and compared.Patients undergoing simBTHA were younger (52.0 ± 12.0 vs 54.9 ± 13.2 years, P = .01), were more likely to be men (55.9% vs 46.9%, P = .04). There was no significant difference in total hospital costs or complications within 90 days for simBTHA compared with staBTHA. The transfusion rate was higher (49.3% vs 10.4%, P < .01), but the LOS was shorter in the simBTHA group (8.7 ± 5.3 vs 12.1 ± 5.6 days, P < .01).There were no differences in total hospital costs or complications within 90 days if patients were carefully selected for simBTHA. Considering the difference in baseline characteristics and the low level of evidence, further randomized controlled studies are necessary.