Clinical applicability of using spherical fitting to find hip joint centers

The functional or sphere-fitting method has been proposed as an alternative to the traditional predictive approach to locating hip centers based on inter-ASIS breadth. In the functional approach, the movement of a marker on the thigh is fit to a sphere whose center coincides with the hip joint center. The first objective of this study was to determine the required parameters that allow an accurate application of a sphere-fitting method. The parameters examined in this study included: (1) the range of motion in flexion-extension and abduction-adduction, (2) the specific algorithm used to fit a sphere to the data, (3) the method of placing markers on the thigh, and (4) the type of motion used to generate points, either walking or a standing leg motion (SLM) trial. This objective was addressed with a computer simulation and clinical data. The second objective was to compare the accuracy of the functional method to the traditional predictive approach in a group of nine human subjects. The location of the hip center estimates from both methods were compared to an ultrasound-determined hip center standard, and linear errors and errors along each axis were compared. Results from the computer simulation indicated that an iterative algorithm is needed, with a method using the derivative yielding slightly more accurate results. Clinical results indicated that the functional method with a standing leg motion trial produced significantly smaller errors in hip joint center estimates (1.34 cm) versus the predictive method (2.16 cm). In addition, the range of error across hips was smaller for the functional method. If high joint center accuracy is needed or in populations characterized by obesity or pelvic asymmetries, the subject specificity and independence from anatomical landmarks characteristic of the functional method would likely provide more accurate results.