The majority of patients present with mild hip pain of insidious onset, a limp and/or reduced hip movements. Pain is usually activity related and localised to the groin but can be referred to the thigh and knee area.

On examination, an antalgic or Trendelenburg gait may be observed. Hip motion is usually maintained at the early stages but both synovitis and abductor spasm may result in some hip irritability. Initially, hip internal rotation and abduction are limited followed by limitation of other hip movements. During the fragmentation stage, hip motion can become severely restricted with the development of flexion and abduction contractures in some patients. Atrophy of the thigh and calf muscles may be present from disuse, secondary to pain. There may be a leg length discrepancy either from true shortening at the collapsed femoral epiphysis or apparent shortening due to an abduction contracture.

The primary imaging modality for LCPD is plain radiographs; standing anteroposterior and frog-leg lateral views of both hips. These X-rays aid in initial diagnosis, staging of the disease and in providing information about the prognosis.

Additional imaging studies to consider:

LCDP has been divided into four radiographic stages according to characteristic features initially described by Waldenstrom:

Four different classification systems have been described: