Controversy has prevailed for many years relating to the safety of one-stage and two-stage total hip arthroplasty (THA) for bilateral disease. We performed a meta-analysis of 1460 studies of which 5 prospective studies met our inclusion criteria. A total of 579 patients had two-stage procedures and 334 had one-stage surgery. The studies showed a low heterogeneity (I2 =0%) allowing pooling of data. No differences were found in the incidence of major complications (odds ratio 0.72 95%CI: 0.45-1.15). One-stage bilateral THA may therefore be a safe procedure.