Pigmented villonodular synovitis of the hip is a quite rare entity characterised by minimal or no symptoms, until severe pressure into the hip joint leads the patient to seek medical care. A 64 year-old woman presented with spontaneous hip pain and, except for a cystic lesion of the femoral lead on the x-rays, the laboratory investigations were normal. During the operation a bleeding mass eroding the femoral head, with minimal acetabular involvement, was found and histological examination revealed pigmented villonodular synovitis. A total hip replacement was performed and the patient was clinically satisfactory 5 years later.
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