Simultaneous bilateral anterior approach total hip arthroplasty has been a successful procedure with high patient demand and good short-term clinical results. Complication rates are acceptable and compare favorably with previously published series. The anterior approach takes advantage of supine positioning, allowing improved intraoperative monitoring and anesthesia care. Short-term rehabilitation goals are met early with this technique. Despite these advantages, providing this simultaneous approach imposes a large financial burden on the hospital and surgeon.