Case Report: C-arm-assisted peri-hip endoscopic debridement for calcific tendinitis at the deep insertion of the gluteus maximus.

Calcific tendinitis commonly affects the rotator cuff; however, involvement of the deep insertion of the gluteus maximus is uncommon and has been described only in limited reports. Deep-seated hip lesions may be difficult to identify on plain radiographs, potentially resulting in delayed diagnosis. We report the case of a 53-year-old woman who presented with atraumatic lateral hip pain and restricted range of motion for 1 month, that was unresponsive to nonsteroidal anti-inflammatory drugs (NSAIDs). Plain radiograph findings were inconclusive. Magnetic resonance imaging (MRI) showed inflammatory edema surrounding the gluteus maximus insertion, and computed tomography (CT) with three-dimensional (3D) reconstruction identified a calcific deposit. Because of persistent pain, functional limitation, and confirmed deep peri-hip calcification, surgical intervention was selected after discussing nonoperative options. Thus, an imaging-guided peri-hip endoscopic debridement was performed under C-arm fluoroscopic guidance following CT and 3D lesion localization. Typical "toothpaste-like" calcific material extruded from the lesion and was completely removed. Histopathological examination confirmed calcific tendinopathy, and postoperative CT verified complete removal of the lesion. At 6 weeks postoperatively, her pain had resolved, and hip function had markedly improved. This case also highlights an effective, imaging-guided diagnostic workflow for deep peri-hip calcific lesions when radiographic findings are inconclusive. Although a CT-planned, C-arm-assisted approach may facilitate rapid recovery, longer-term follow-up is required to evaluate durability, recurrence, tendon healing, and potential delayed complications.