EP3.8 Within Reach—Medial approach hip arthroscopy is a valuable and safe approach for traditionally out of reach hip pathology: a case report utilizing novel technique for excision ofpigmented villonodular synovitis of the inferior femoral neck

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ID: 331196
2026
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Abstract
Abstract Introduction Modern hip arthroscopy has been highly refined and is a proven technique allowing for minimally invasive treatment of intra articular hip pathology. There are, however, limitations in access using standard anterior and lateral based portals. Little is published regarding alternative medial based hip arthroscopy. Medial hip arthroscopy can be a safe and effective technique in treatment of pathologies not accessible with standard approaches that may otherwise require large open approaches. We present a case report of successful excision of nodular pigmented villonodular synovitis (PVNS) of the inferior femoral neck via medial hip arthroscopy utilizing a novel technique aided by Color Flow Doppler Ultrasound (CFDU). Clinical History 41-year-old female presented with worsening left hip pain, mechanical symptoms, and difficulty with ambulation. Magnetic resonance imaging demonstrated an inferior intra-articular mass consistent with nodular PVNS. Non-operative measures were unable to achieve meaningful symptomatic relief. Ultimately, via two-portal medial hip arthroscopy the mass was successfully excised and local synovectomy performed with capsule closure. Surgical Technique The patient was positioned supine on flat Jackson table and induced under general anesthesia. The leg was flexed, abducted, and externally rotated. A spinal needle was used to establish a sub-adductor longus posteromedial portal 1cm distal to the groin crease aimed towards the inferior femoral head neck junction under fluoroscopy. CFDU was utilized in conjunction with fluoroscopy in a novel fashion to ensure safe portal trajectory and position relative to the neurovascular structures. Next, an anteromedial portal, anterior to the adductor was established 1cm distal to the groin crease also using CFDU. Utilizing these portals and through an inferior capsulotomy the 2.2cm mass was isolated and removed en bloc with synovectomy performed followed by capsule closure. She was independently ambulatory with minimal reported pain on post op day one. Narcotics were not required for post operative pain.
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Authors Stephanie Chang, MD Stephan Zmugg
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Journal Journal of hip preservation surgery
Year 2026
DOI
10.1093/jhps/hnag043.293
URL
https://doi.org/10.1093/jhps/hnag043.293
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