BACKGROUND Primary synovial chondromatosis commonly involves large joints such as the knee and hip. The optimal approaches for successful surgical management of symptomatic primary synovial chondromatosis of the hip joint are controversial. METHODS The current study reviewed 9 patients with primary synovial chondromatosis of the hip who underwent surgical treatment between 2000 and 2005. By identification of the surgical indications, we chose the optimal surgical approach, open arthrotomy or arthroscopic surgery, for a definite treatment. RESULTS Of the 9 patients, 4 underwent open arthrotomy and 5 underwent hip arthroscopic surgery. The mean follow-up duration was 24.9 months (range, 12-50). There were no perioperative or postoperative complications. There was 1 recurrence 2 years after the first arthroscopic surgery. All hips remained in stationary condition on radiological follow-up except for 1 hip, the recurrence case. The mean Harris Hip Score at the 12-month follow-up was 93.7 (range, 90-99). CONCLUSIONS Surgical treatment for primary synovial chondromatosis of the hip proved beneficial for these patients. By means of identified indications, selecting an appropriate surgical approach provides a rapid recovery and low incidence of recurrence.