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The clinical presentation in the vast majority of instances is that of an otherwise healthy child complaining of mild pain in the hip, thigh or knee or having a limp that is noticed by the parents. Very often the symptoms are ignored by the parents for a while on the assumption that the child may have had some trivial injury at play. The pain is most commonly activity-related. There is no fever or any constitutional symptoms. The child may have a history of hyperactivity . Range of motion examination will show moderate reduction in the range of passive abduction and internal rotation of the hip associated with some muscle spasm. Occasionally, all move ments may be limited by marked muscle spasm. Early in the disease, if the child is examined under anesthesia, the movement will be normal as the muscle spasm is relieved by the anesthetic. Once the femoral head is deformed limitation of movement may persist even under anesthesia. A limp is usually present; in the early phase of the disease the gait is usually antalgic, later on when the mechanics of the hip is altered or the epiphyseal growth is affected a Trendelenburg gait or a short-limb gait may develop. Bilateral involvement is infrequent but when it does occur the disease onset is seldom simultaneous in both hips. When imaging shows features suggestive of bilateral synchronous disease, skeletal dysplasia, Gaucher’s disease and hypothyroidism must be excluded as radiographic features of the hips in these conditions may resemble LCPD. The hip pain tends to reduce as the disease progresses in most of the children. Occasionally, recurrence of pain and sudden reduction in the range hip motion may develop as the femoral head deforms during the advanced stage of fragmentation (Stage 2b). In these cases, attempted hip abduction causes pain and a radiograph taken in abduction may reveal a phenomenon called ‘hinge abduction’ where the lateral aspect of the femoral head impinges against the acetabular margin