To evaluate the clinical efficacy of arthroscopic subsurface membrane resection with herbal fumigation in the treatment of diffuse hyperpigmented villous nodular synovitis and its application value. Methods A before-and-after controlled study design was used to compare the efficacy of 30 patients who met the inclusion criteria before arthroscopy and after 6 and 12 months of follow-up, and the observation indexes included the degree of pain, swelling and mobility. Results There was a statistically significant improvement in pain, swelling and mobility at the 1st and 2nd follow-ups compared to the pre-treatment period (p<0.05). The efficacy of the two follow-ups was comparable, and the difference was not statistically significant (P>0.05). Conclusion Arthroscopic synovectomy with herbal fumigation for the treatment of diffuse hyperpigmented villous nodular synovitis has good efficacy and is not easy to recur, which is worth advocating clinically.