A 15-year-old, otherwise healthy, female presented with right hip pain, which had worsened over 2 years. Radiographs, computed tomography imaging and physical examination confirmed the diagnosis of osteoid osteoma of the proximal posteromedial femoral neck of the right hip. After failed conservative measures, including attempted radiofrequency ablation, and with persistent unrelenting pain, surgical intervention was offered. The location of the lesion made it challenging to consider hip arthroscopy using standard arthroscopic portals, due to medial periarticular neurovascular structures. The options included open surgical dislocation and the less invasive, yet uncommonly utilized hip arthroscopy using medial portals. An arthroscopic approach using medial portals allowed for complete excision of the lesion and successful resolution of her symptoms.