Patent Publication Number: US-2023157827-A1

Title: Expandable augment system for acetabular cup

Description:
INCORPORATION BY REFERENCE TO ANY PRIORITY APPLICATIONS 
     Any and all applications for which a foreign or domestic priority claim is identified in the Application Data Sheet as filed with the present application are hereby incorporated by reference under 37 CFR 1.57. 
     BACKGROUND 
     Field 
     The present disclosure is directed to an augment system for an acetabular cup for use in hip joint replacement surgical procedures, and more particularly to an expandable and modular augment system for an acetabular cup. 
     Description of the Related Art 
     Hip joint replacement surgical procedures involve the implantation of an acetabular cup in the pelvis bone that receives a liner and a head of a femoral stem implant that is inserted into the femur bone. Where the pelvis has defects and/or loss of bone, an augment is needed to secure the acetabular cup in place. 
     SUMMARY 
     In accordance with one aspect of the disclosure, an expandable augment system is provided for use with an acetabular cup. The expandable augment system can include an expandable augment module that is adjustable in size that can be adjusted incrementally between a fully collapsed state and an expanded state. A first portion of the expandable augment module is attachable to an outer surface of an acetabular cup and a second portion of the expandable augment module is attachable to bone or to a fixed augment module (e.g., a fixed angle augment module) that is attached to bone and interposed between the adjustable augment module and bone. Advantageously, the expandable augment can be used to account for different amounts or shape of bone loss or defects in the pelvis with the same augment module, reducing the number of augments needed for a surgical procedure where loss of bone or defects are present. Additionally, the expandable augment can advantageously be adjusted in size incrementally, allowing for its use with different sized acetabular cups. 
     In accordance with an aspect of the disclosure, an augment for an acetabular cup is provided. The augment includes and expandable augment body. The expandable augment body comprises a first plate configured to couple with a bone or a fixed augment module, the first plate having one or more first openings configured to receive therethrough corresponding one or more first fasteners. The expandable augment body also comprises a second plate configured to couple to an outer surface of an acetabular cup, the second plate connected to the first plate and configured to pivot relative to the first plate between a first position where the second plate is proximate the first plate along its length and a second position where at least a portion of the second plate is spaced from the first plate. The second plate has one or more second openings configured to be coaxial with the one or more first openings when in the first position, the one or more second openings having a larger size than the one or more first openings. 
     In accordance with another aspect of the disclosure, an augment kit for an acetabular cup is provided. The kit comprises an expandable augment body. The expandable augment body comprises a first plate having one or more first openings configured to receive therethrough corresponding one or more first fasteners. The expandable augment body also comprises a second plate configured to couple to an outer surface of an acetabular cup, the second plate connected to the first plate and configured to pivot relative to the first plate between a first position where the second plate is proximate the first plate along its length and a second position where at least a portion of the second plate is spaced from the first plate. The second plate has one or more second openings configured to be coaxial with the one or more first openings when in the first position, the one or more second openings having a larger size than the one or more first openings. The kit also comprises one or more fixed augment modules. Each of the fixed augment modules has a third plate and a fourth plate connected to the third plate and extending at a fixed angle relative to the third plate. The third plate has one or more openings configured to receive corresponding fasteners therethrough to couple the fixed augment module to bone. The fourth plate has one or more openings configured to receive the one or more first fasteners therethrough to couple the fixed augment module to the expandable augment body. At least one of the one or more fixed augment modules has a different fixed angle. 
     In accordance with another aspect of the disclosure, a method for implanting an acetabular cup is provided. The method comprises evaluating a size of an acetabular hole and one or more defects in a pelvis bone proximate the acetabulum. The method also comprises attaching an expandable augment module to the pelvis bone or to a fixed angle augment module attached to the pelvis bone. The method also comprises adjusting a size of the expandable augment module to contact an acetabular cup. The method also comprises applying cement between the acetabular cup and bone, and applying cement between plates of the expandable augment module or plates of the fixed angled augment module to thereby fix the acetabular cup in the bone. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The patent or application file contains at least one drawing executed in color. Copies of this patent or patent application publication with color drawing(s) will be provided by the Office upon request and payment of the necessary fee. 
         FIG.  1    is a schematic cross-sectional view of an expandable augment for use with an acetabular cup, the expandable augment in a first position. 
         FIG.  2    is a schematic cross-sectional view of the expandable augment of  FIG.  1   , the expandable augment in a second position. 
         FIG.  3    is a schematic top view of the expandable augment of  FIG.  1   . 
         FIG.  4    is a schematic perspective view of the expandable augment of  FIG.  3   . 
         FIG.  5    is a schematic view of an expandable augment with a support structure, in a first position. 
         FIG.  6    is a schematic view of an expandable augment with a support structure, in a second position. 
         FIG.  7 A  is a schematic partial view of a hinge portion of the expandable augment. 
         FIG.  7 B  is a schematic partial view of a hinge portion of the expandable augment 
         FIG.  8 A  shows a schematic side view and top view of an expandable augment with a support structure. 
         FIG.  8 B  shows a schematic side view and top view of an expandable augment with a support structure. 
         FIG.  8 C  shows a schematic side view and top view of an expandable augment with a support structure. 
         FIG.  8 D  shows a schematic side view and top view of an expandable augment with a support structure. 
         FIG.  8 E  shows a schematic side view and top view of an expandable augment with a support structure. 
         FIG.  8 F  shows a schematic side view and top view of an expandable augment with a support structure. 
         FIG.  9    is a schematic view of an expandable augment implanted in bone and attached to an acetabular cup. 
         FIG.  10    is a schematic cross-sectional view of a fixed angle augment module. 
         FIG.  11    is a schematic assembled view of a fixed angle augment module and expandable augment. 
         FIG.  12    is a schematic view of the fixed angle augment module attached to bone and the expandable augment, the expandable augment attached to an acetabular cup. 
         FIG.  13    is a schematic view of a kit including the expandable augment and fixed augment module. 
         FIG.  14    is a flow chart of a method for using the expandable augment. 
     
    
    
     DETAILED DESCRIPTION 
     Disclosed herein are augment modules for use in a hip joint surgical procedure, such as hip joint revision surgery, where an acetabular cup is implanted in the acetabulum of the pelvis bone. The acetabular cup can at least partially receive a liner, which can at least partially receive a ball of a femoral stem implant. The augment modules disclosed below advantageously provide structural support to the acetabular cup where bone loss or defects in the pelvis bone prevent the implantation of the acetabular cup on its own (e.g., without the use of an augment). 
       FIGS.  1 - 4    show an expandable augment module  100  with a first plate  10  and a second plate  20  movably coupled to the first plate  10  by a hinge  30 . In one implementation, the first and second plates  10 ,  20  can have the same thickness. In another implementation, the first and second plates  10 ,  20  can have different thicknesses. In one implementation, the first and second plates  10 ,  20  can span approximately the same area. In another implementation the first and second plates  10 ,  20  can have different areas (e.g., have different shapes). The first and second plates  10 ,  10  can be curved (e.g., in an X direction and a Y direction, as shown in  FIG.  3   ). Advantageously, the first plate  10  can be curved so that it has a contour that approximates a contour of an outer surface of an acetabular cup AC (see  FIG.  8   ). In one implementation, the first plate  10  and second plate  20  have approximately the same curvature. In another implementation, the first plate  10  and second plate  20  can have different curvatures (e.g., the second plate  20  can have a larger radius of curvature than the first plate  10 ). In one implementation, the expandable augment module  100  can be made of metal (e.g., titanium). In another implementation, the expandable augment module  100  can be made of a biocompatible polymer material (e.g., polyethylene, cross-linked polyethylene). 
     The outer surface  11  of the first plate  10  and the outer surface  21  of the second plate  20  can be porous to facilitate attachment to bone cement and/or bone to aid in solidifying the implantation of the expandable augment module  100 . For example, where the expandable augment module  100  is attached to bone and to an acetabular cup (e.g., as shown in  FIG.  8   ), the porous outer surface  21  of the second plate  20  can facilitate bone in or on growth to aid in solidifying the implantation of the expandable augment module  100  to bone. The inner surface  13  of the first plate  10  and the inner surface  23  of the second plate  20  can be porous or rough (e.g., not smooth) to facilitate attachment of bone cement thereto. 
       FIG.  1    shows the expandable augment module  100  in a first position (e.g., a closed, collapsed or retracted position) where the first plate  10  is adjacent (e.g., in contact with) the second plate  20 . In the first position, the expandable augment module  100  can provide a first spacing or thickness D1 (e.g., maximum distance between an outer surface of the first plate  10  and an outer surface of the second plate  20 ). In one example, the first spacing or thickness D1 can be approximately 5 mm. However, the first pacing or thickness D1 can have other suitable dimensions.  FIG.  2    shows the expandable augment module  100  in a second position (e.g., an open or expanded position) where at least a portion of the first plate  10  is spaced (e.g., separated by a space or opening) from the second plate  20 . In the second position, the expandable augment module  100  can provide a second spacing or thickness D2 (e.g., maximum distance between an outer surface of the first plate  10  and an outer surface of the second plate  20 ). In one example, the first spacing or thickness D1 can be approximately 30 mm. However, the second spacing or thickness D2 can have other suitable dimensions. Though  FIG.  2    shows one expanded position for the expandable augment module  100 , one of skill in the art will recognize that multiple (e.g. a plurality of) expanded positions (e.g., at 5 mm, 10 mm, 15 mm, 20 mm, 25 mm, 30 mm) between the first position (shown in  FIG.  1   ) and a maximum expanded position are possible, to vary a spacing or thickness D provided by the expandable augment module  100 . In one implementation, the expandable augment system  100  can be incrementally expanded (e.g., in 5 mm increments) between the first position (e.g., closed, collapsed or retracted position in  FIG.  1   ) and a maximum expanded position (e.g., to multiple intermediate expanded positions). In another implementation, the expandable augment system  100  can be continuously adjustable between the first position and a maximum expanded position. 
     The first plate  10  has one or more openings (e.g., first openings)  12  that extend through (e.g., completely through) the first plate  10 . The second plate has one or more openings (e.g., second openings)  22  that extend through (e.g., completely through) the second plate  20 . The openings  12  and  22  are aligned (e.g., coaxial) when the expandable augment module  100  is in the first position (e.g., closed, collapsed or retracted position shown in  FIG.  1   ). The openings  12  are larger than the openings  22  and allow one or more fasteners  200  to be inserted through the openings  12  and openings  22  while the expandable augment module  100  is in the first position (shown in  FIG.  1   ), such as to fix or attach the expandable augment module  100  to bone (e.g., the pelvis bone), and advantageously allows the adjustment of the first plate  10  away from the second plate  20  (e.g., to move the expandable augment module  100  to the second position, shown in  FIG.  2   ) while the second plate  20  is fixed (by the fastener(s)  200 ) to bone. For example, the openings  22  can be larger in size than a head of the fastener(s)  200 , whereas the openings  12  can be smaller in size than the head of the fastener(s)  200 . As shown in  FIG.  4   , the expandable augment module  100  can have one or more openings  25  in the second plate  20  that align with one or more cutout  15  in a rim of the first plate  10 . The opening(s)  25  and cutout(s)  15  can be sized to receive a wire to provisionally secure the expandable augment module  100  to bone (e.g., by inserting the wire through the cutout(s)  15  and the opening(s) or hole(s)  25  and into bone) prior to securing the expandable augment module  100  with the fastener(s)  200 . Advantageously, the cutout(s)  15  allow the wire to be removed (e.g., escape) by moving the wire laterally relative to the cutout(s)  15 . 
       FIGS.  5 - 6    show an implementation of the expandable augment system  100  that (optionally) includes a support structure  40  having a first support member  42  and a second support member  44  that extend between the first plate  10  and the second plate  20 . The first and second support members  42 ,  44  are movably coupled to each other via a pivot or joint  46  and can be movably coupled (e.g., slidably coupled) to the first and second plates  10 ,  20 , advantageously allowing the first and second support members  42 ,  44  to move between a first position (shown in  FIG.  5   ), where at least a portion of the first and second plates  10 ,  20  are relatively closer to each other, and second position (shown in  FIG.  6   ), where at least a portion of the first and second plates  10 ,  20  are relatively farther apart from each other. The first and second support members  42 ,  44  advantageously provide structural support to the expandable augment module  100  when in an expanded position (e.g., in a position other than the first position shown in  FIG.  1   ) to facilitate maintaining the expandable augment module  100  in the expanded position. In one implementation, the support structure can include a ratchet-like assembly that allows the first plate  10  to move relative to the second plate  20  incrementally, the ratchet system allowing the expandable augment module  100  to retain its expanded position at each increment of its expansion. 
       FIG.  7 A  shows a portion of an expandable augment module  100 ′. Some of the features of the expandable augment module  100 ′ are similar to features of the expandable augment module  100  in  FIGS.  1 - 4   . Thus, reference numerals used to designate the various components of the expandable augment module  100 ′ are identical to those used for identifying the corresponding components of the expandable augment module  100  in  FIGS.  1 - 4   , except that a “ ′ ” has been added to the numerical identifier. Therefore, the structure and description for the various features of the expandable augment module  100  in  FIGS.  1 - 4    are understood to also apply to the corresponding features of the expandable augment module  100 ′ in  FIG.  7 A , except as described below. 
     The expandable augment module  100 ′ differs from the expandable augment module  100  in that the hinge  30 ′ is a living hinge. The material of the first plate  10 ′ is one piece with the material of the second plate  20 ′ but has a portion  32 ′ with reduced thickness  32 ′ at the hinge  30 ′ that facilitates the movement of the first plate  10 ′ relative to the second plate  20 ′ about the hinge  30 ′. 
       FIG.  7 B  shows a portion of an expandable augment module  100 ″. Some of the features of the expandable augment module  100 ″ are similar to features of the expandable augment module  100  in  FIGS.  1 - 4   . Thus, reference numerals used to designate the various components of the expandable augment module  100 ″ are identical to those used for identifying the corresponding components of the expandable augment module  100  in  FIGS.  1 - 4   , except that a “ ″ ” has been added to the numerical identifier. Therefore, the structure and description for the various features of the expandable augment module  100  in  FIGS.  1 - 4    are understood to also apply to the corresponding features of the expandable augment module  100 ″ in  FIG.  7 B , except as described below. 
     The expandable augment module  100 ″ differs from the expandable augment module  100  in that the hinge  30 ″ is a separate component from the first plate  10 ″ and second plate  20 ″. The hinge  30 ″ has a first member  31   a ″ attached to the first plate  10 ″ and a second member  31   b ″ attached to the second member  31   b ″. The first and second members  31   a ″,  31   b ″ are pivotally coupled to each other by a pin  32 ″. The hinge  30 ″ facilitates the movement of the first plate  10 ″ relative to the second plate  20 ″ about the pin  32 ″. 
       FIG.  8 A  shows a schematic side view (left image) and top view (right image) of an expandable augment module  100 A. Some of the features of the expandable augment module  100 A are similar to features of the expandable augment module  100 ,  100 ′,  100 ″ in  FIG.  1   -7B. Thus, reference numerals used to designate the various components of the expandable augment module  100 A are identical to those used for identifying the corresponding components of the expandable augment module  100 ,  100 ′,  100 ″ in  FIG.  1   -7B, except that an “A” has been added to the numerical identifier. Therefore, the structure and description for the various features of the expandable augment module  100 ,  100 ′,  100 ″ in  FIG.  1   -7B are understood to also apply to the corresponding features of the expandable augment module  100 A in  FIG.  8 A , except as described below. 
     The expandable augment module  100 A differs from the expandable augment module  100  in that the support structure  40 A is a post (e.g., linear member)  40 A that extends between the first plate  10 A and the second plate  20 A. The post  40 A can be a separate component inserted between the first plate  10 A and the second plate  20 A. In another implementation, the post  40 A can be integral with the first plate  10 A and the second plate  20 A. the post  40 A can be disposed toward a rear of the expandable augment  100 A (e.g., close to the location of the hinge). In one implementation, the post  40 A is expandable (e.g., has one portion that telescopes relative to a second portion to allow the length of the post  40 A to change), such as incrementally between different length setpoints, which can advantageously support the expandable augment  100 A in different expanded positions (e.g., between 5 mm and 30 mm at the opening of the augment, for example, as discussed above). In another implementation, the post  40 A has one portion that ratchets relative to another to achieve incremental changes in length to support different expanded positions of the expandable augment  100 A. In another implementation the post  40 A can be slidably coupled to the first plate  10 A and second plate  20 A so that it moves between a position generally parallel to the first and second plates  10 A,  20 A (when the expandable augment  100 A is in the closed position), different angular positions as the first plate  10 A is moved away from the second plate  20 A, and/or a position generally perpendicular to one or both of the first and second plates  10 A,  20 A when the expandable augment  100 A is in a maximum expanded position. In another implementation, the post  40 A is of a material that plastically deforms when stretched (e.g., allowing the incremental change in length of the post  40 A and therefore the incremental change in expanded state of the expandable augment  40 A). In one implementation, the post  40 A can have a circular cross-section. In another implementation, the post  40 A can have a non-circular (e.g., square, rectangular) cross-section. Though  FIG.  8 A  shows one post  40 A, one of skill in the art will recognize that the expandable augment  100 A can have multiple posts between the first plate  10 A and the second plate  20 A. 
       FIG.  8 B  shows a schematic side view (left image) and top view (right image) of an expandable augment module  100 B. Some of the features of the expandable augment module  100 B are similar to features of the expandable augment module  100 A in  FIG.  8 A , which is based on the expandable augment  100 ,  100 ′,  100 ″ in  FIG.  1 - 7 B . Thus, reference numerals used to designate the various components of the expandable augment module  100 B are identical to those used for identifying the corresponding components of the expandable augment module  100 A in  FIG.  8 A , except that a “B” instead of an “A” has been added to the numerical identifier. Therefore, the structure and description for the various features of the expandable augment module  100 A in  FIG.  8 A , which incorporates the description for the expandable augment  100 ,  100 ′,  100 ″ in  FIG.  1 - 7 B , are understood to also apply to the corresponding features of the expandable augment module  100 B in  FIG.  8 B , except as described below. 
     The expandable augment module  100 B differs from the expandable augment module  100 A in that the support structure  40 B is a post (e.g., linear member)  40 B that extends between the first plate  10 B and the second plate  20 B proximate (e.g., near, adjacent) the opening of the expandable augment module  100 B. The post  40 B can have a similar (e.g., same, identical) structure as the post (e.g., linear member)  40 A described above (e.g., have telescoping portions, have ratchet portions, have plastically deformable portion). 
       FIG.  8 C  shows a schematic side view (left image) and top view (right image) of an expandable augment module  100 C. Some of the features of the expandable augment module  100 C are similar to features of the expandable augment modules  100 A and  100 B in  FIGS.  8 A- 8 B , which are based on the expandable augment  100 ,  100 ′,  100 ″ in  FIG.  1   -7B. Thus, reference numerals used to designate the various components of the expandable augment module  100 C are identical to those used for identifying the corresponding components of the expandable augment modules  100 A and  100 B in  FIGS.  8 A- 8 B , except that a “C” has been added to the numerical identifier. Therefore, the structure and description for the various features of the expandable augment modules  100 A and  100 B in  FIGS.  8 A- 8 B , which incorporates the description for the expandable augment  100 ,  100 ′,  100 ″ in  FIG.  1   -7B, are understood to also apply to the corresponding features of the expandable augment module  100 C in  FIG.  8 C , except as described below. 
     The expandable augment module  100 C differs from the expandable augment modules  100 A and  100 B in that the support structure  40 C is a post (e.g., linear member)  40 C that extends at an angle (e.g., a non-perpendicular angle, an acute angle) relative to the first plate  10 C and to the second plate  20 C. The post (e.g., linear member)  40 C can have a first end attached to the second plate  20 C proximate the opening of the expandable augment module  100 C and a second end attached to the first plate  10 C proximate the closed end (e.g. hinge end) of the expandable augment module  100 C. In another implementation, the first end of the post  40 C can attached to the first plate  10 C proximate the opening of the expandable augment module  100 C and a second attached to the second plate  20 C proximate the closed end (e.g. hinge end) of the expandable augment module  100 C. The post  40 C can have a similar (e.g., same, identical) structure as the post (e.g., linear member)  40 A described above (e.g., have telescoping portions, have ratchet portions, have plastically deformable portion). 
       FIG.  8 D  shows a schematic side view (left image) and top view (right image) of an expandable augment module  100 D. Some of the features of the expandable augment module  100 D are similar to features of the expandable augment module  100 C in  FIG.  8 C , which is based on the expandable augment  100 ,  100 ′,  100 ″ in  FIG.  1   -7B. Thus, reference numerals used to designate the various components of the expandable augment module  100 D are identical to those used for identifying the corresponding components of the expandable augment module  100 C in  FIG.  8 C , except that a “D” has been added to the numerical identifier. Therefore, the structure and description for the various features of the expandable augment module  100 C in  FIG.  8 C , which incorporates the description for the expandable augment  100 ,  100 ′,  100 ″ in  FIG.  1 - 7 B , are understood to also apply to the corresponding features of the expandable augment module  100 D in  FIG.  8 D , except as described below. 
     The expandable augment module  100 D differs from the expandable augment module  100 C in that the support structure  40 D is not shaped like a post, but can have an irregular form factor. In the illustrated implementation, the support structure  40 D is triangular when viewed from the top (right image) and linear when viewed from the side (left image). However, the support structure  40 D can have other shapes (e.g., be rectangular when viewed from the top). The support structure  40 D can in one implementation extend at an angle (e.g., a non-perpendicular angle, an acute angle) relative to the first plate  10 D and to the second plate  20 D. The support structure  40 D can have a first end attached to the second plate  20 D proximate the closed end (e.g., hinged end) of the expandable augment module  100 D and a second end attached to the first plate  10 D proximate the open end of the expandable augment module  100 D. In another implementation, the first end can be attached to the first plate  10 D proximate the closed end (e.g., hinged end) of the expandable augment module  100 D and a second end attached to the second plate  10 D proximate the open end of the expandable augment module  100 . The support structure  40 D can have a similar (e.g., same, identical) structure as the support structure  40 A described above (e.g., have telescoping portions, have ratchet portions, have plastically deformable portion). 
       FIG.  8 E  shows a schematic side view (left image) and top view (right image) of an expandable augment module  100 E. Some of the features of the expandable augment module  100 E are similar to features of the expandable augment module  100 D in  FIG.  8 D , which is based on the expandable augment  100 ,  100 ′,  100 ″ in  FIG.  1   -7B. Thus, reference numerals used to designate the various components of the expandable augment module  100 E are identical to those used for identifying the corresponding components of the expandable augment module  100 D in  FIG.  8 D , except that an “E” has been added to the numerical identifier. Therefore, the structure and description for the various features of the expandable augment module  100 D in  FIG.  8 D , which incorporates the description for the expandable augment  100 ,  100 ′,  100 ″ in  FIG.  1   -7B, are understood to also apply to the corresponding features of the expandable augment module  100 E in  FIG.  8 E , except as described below. 
     The expandable augment module  100 E differs from the expandable augment module  100 D in that the support structure has a hinge (e.g. living hinge). In the illustrated implementation, the support structure  40 E is triangular (e.g., with the pointed end toward the closed or hinged end of the expandable augment module) when viewed from the top (right image) and has two linear portions connected at a hinged location when viewed from the side (left image). In another implementation, the support structure  40 E can be triangular with the pointed end toward the open end of the expandable augment module  100 E. However, the support structure  40 E can have other shapes (e.g., be rectangular when viewed from the top). The support structure  40 E can in one implementation extend at an angle (e.g., a non-perpendicular angle, an acute angle, the same angle) relative to the first plate  10 E and to the second plate  20 E. The support structure  40 E can have a first end attached to the second plate  20 E proximate the open end of the expandable augment module  100 E and a second end attached to the first plate  10 E proximate the open end of the expandable augment module  100 E, with the hinged portion disposed further toward the closed end (e.g. hinged end) of the expandable augment module  100 E. The hinged portion of the support structure  40 E can be a living hinge in one implementation. In another implementation, the hinged portion of the support structure  40 E can be a ratcheted hinge, allowing the incremental movement of the support structure  40 E to different expanded setpoints to thereby support the incremental opening of the expandable augment module 100E. 
       FIG.  8 F  shows a schematic side view (left image) and top view (right image) of an expandable augment module  100 F. Some of the features of the expandable augment module  100 F are similar to features of the expandable augment module  100 E in  FIG.  8 E , which is based on the expandable augment  100 ,  100 ′,  100 ″ in  FIG.  1   -7B. Thus, reference numerals used to designate the various components of the expandable augment module  100 F are identical to those used for identifying the corresponding components of the expandable augment module  100 E in  FIG.  8 E , except that an “F” has been added to the numerical identifier. Therefore, the structure and description for the various features of the expandable augment module  100 ED in  FIG.  8 E , which incorporates the description for the expandable augment  100 ,  100 ′,  100 ″ in  FIG.  1 - 7 B , are understood to also apply to the corresponding features of the expandable augment module  100 F in  FIG.  8 F , except as described below. 
     The expandable augment module  100 F differs from the expandable augment module  100 E in that it has a support structure  40 F with an opposite orientation than that of the support structure  40 E. 
     In the illustrated implementation, the support structure  40 F is triangular (e.g., with the pointed end toward the open end of the expandable augment module) when viewed from the top (right image) and has two linear portions connected at a hinged location when viewed from the side (left image). In another implementation, the support structure  40 F can be triangular with the pointed end toward the closed or hinged end of the expandable augment module  100 F. However, the support structure  40 F can have other shapes (e.g., be rectangular when viewed from the top). The support structure  40 F can in one implementation extend at an angle (e.g., a non-perpendicular angle, an acute angle, the same angle) relative to the first plate  10 F and to the second plate  20 F. The support structure  40 F can have a first end attached to the second plate  20 F proximate the open end of the expandable augment module  100 F and a second end attached to the first plate  10 F proximate the open end of the expandable augment module  100 F, with the hinged portion disposed further toward the open end of the expandable augment module  100 F. The hinged portion of the support structure  40 F can be a living hinge in one implementation. In another implementation, the hinged portion of the support structure  40 F can be a ratcheted hinge, allowing the incremental movement of the support structure  40 F to different expanded setpoints to thereby support the incremental opening of the expandable augment module  100 F. 
       FIG.  9    shows a schematic partial view of an acetabular cup AC implanted in an acetabulum of a pelvis bone PB, where at least a portion of the acetabular cup AC is supported by the expandable augment module  100 ,  100 ′,  100 ″. The expandable augment module  100 ,  100 ′,  100 ″ provides structural support to the acetabular cup AC where bone loss or defects in the pelvis bone prevent the implantation of the acetabular cup AC without an augment. Advantageously, the expandable augment module  100 ,  100 ′,  100 ″ allow the surgeon to evaluate the size of the hole in the acetabulum and evaluate the defects or loss of bone, then attach the expandable augment module  100 ,  100 ′,  100 ″ to the pelvis bone PB with one or more fasteners  200  (e.g., screws), and adjust (e.g., expand) the expandable augment module  100 ,  100 ′,  100 ″ (e.g., by moving the first plate  10  away from the second plate  20 ) to a location where the first plate  10 ,  10 ′,  10 ″ will support (e.g., contact, engage) an outer surface of the acetabular cup AC. The adjustability of the expandable augment module  100 ,  100 ′,  100 ″ advantageously allows its use with a variety of different acetabular cup AC sizes, thereby obviating the need for having multiple augment module sizes per acetabular cup size. Once in place, bone cement BC can be applied to fix the acetabular cup to bone, as well as applied between the plates  10 ,  20  of the expandable augment module  100 ,  100 ′,  100 ″ to secure the acetabular cup AC and expandable augment module  100 ,  100 ′,  100 ″ in place. In one implementation, bone cement can be used to fix the acetabular cup AC to the expandable augment module  100 ,  100 ′,  100 ″. In another implementation, screws can (alternatively or in addition to bone cement) be used to fix the acetabular cup AC to the expandable augment module  100 ,  100 ′,  100 ″. 
       FIG.  10    shows a cross-sectional view of a fixed angle augment module  300 . The fixed angle augment module  300  can have a first plate  310  and a second plate  320  that form a single piece (e.g., monolithic, seamless), where the first plate  310  joins the second plate  320  at a fixed angle α. The fixed angle augment module  300  can optionally be of the same material and have the same profile (e.g., as viewed in top view) as the expandable augment module  100 ,  100 ′,  100 ″. The first plate  310  can have one or more openings  312  therethrough and the second plate  320  can have one or more openings  322  therethrough. The openings  312 ,  322  can be aligned so that a fastener  200  can extend through both the openings  312  and the openings  322  at the same time. 
     The outer surface  311  of the first plate  310  and the outer surface  321  of the second plate  320  can be porous to facilitate attachment to bone cement and/or bone to aid in solidifying the implantation of the fixed angle augment module  300 . For example, where the fixed angle augment module  300  is attached to bone and to the expandable augment module  100  (e.g., as shown in  FIG.  12   ), the porous outer surface  321  of the second plate  320  can facilitate bone in or on growth to aid in solidifying the implantation of the fixed angle augment module  300  to bone. The inner surface  313  of the first plate  310  and the inner surface  323  of the second plate  320  can be porous or rough (e.g., not smooth) to facilitate attachment of bone cement thereto. 
       FIG.  11    shows a cross-sectional view of the fixed angle augment module  300  of  FIG.  10    coupled to the expandable augment module  100 ,  100 ′,  100 ″ with one or more fasteners  200 . Though not shown, the fasteners  200  can extend through both the openings  312  and openings  322  of the fixed angle augment module  300  at the same time. Advantageously, the fixed angle augment module  300 , when coupled to the expandable augment module  100 ,  100 ′,  100 ″ allows the support of the acetabular cup AC where the size of the bone loss or defect in the pelvis bone is larger. As shown in  FIG.  12   , the fixed angle augment module can be fixed to the pelvis bone PB and to the expandable augment module  100 ,  100 ′,  100 ″. Though  FIG.  12    shows separate fasteners  200  coupling the fixed angle augment module  300  to bone PB and separate fasteners  200  coupling the expandable augment module  100 ,  100 ′,  100 ″ to the fixed angle augment module  300 , in some implementations the same fastener couples the expandable augment module  100 ,  100 ′,  100 ″ to the fixed angle augment module  300 , and couples the fixed angle augment module  300  to the pelvis bone PB. The surgeon can then adjust (e.g., expand) the expandable augment module  100 ,  100 ′,  100 ″ (e.g., by moving the first plate  10  away from the second plate  20 ) to a location where the first plate  10 ,  10 ′,  10 ″ will support (e.g., contact, engage) an outer surface of the acetabular cup AC. Once in place, bone cement BC can be applied to fix the acetabular cup to bone, as well as applied between the plates  10 ,  20  of the expandable augment module  100 ,  100 ′,  100 ″ and plates  310 ,  320  of the fixed angle augment module to secure the acetabular cup AC and augment module  100 ,  100 ′,  100 ″ in place. In one implementation, bone cement can be used to fix the acetabular cup AC to the expandable augment module  100 ,  100 ′,  100 ″. In another implementation, screws can (alternatively or in addition to bone cement) be used to fix the acetabular cup AC to the expandable augment module  100 ,  100 ′,  100 ″. 
       FIG.  13    shows an augment kit  400  for use with an acetabular cup AC in hip joint replacement or revision surgery. The kit  400  can include one or more expandable augment modules  100 ,  100 ′,  100 ″. The kit  400  can also include multiple fixed angle augment modules, at least two of which can have a different angle between plates of the module. In the illustrated implementation, the kit  400  includes a first fixed angle augment module  300 A with first and second plates  310 A,  320 A joined at a at a fixed angle α1. The kit  400  can also include a second fixed angle augment module  300 B with first and second plates  310 B,  320 B joined at a at a fixed angle α2 smaller than fixed angle α1. The augment kit  400  can be in a single package  410  that includes the expandable augment module  100 ,  100 ′,  100 ″ and fixed angle augment module(s)  300 A,  300 B. The augment kit  300  advantageously simplifies the number of augment components needed for use in hip replacement or revision surgery and obviates the need for having multiple augment modules of different sizes for each acetabular cup size. 
       FIG.  14    shows a flow chart of a process or method  500  for using an augment in hip joint replacement or revision surgery. The method  500  includes the step  510  of evaluating the size of the acetabular hole in the pelvis bone (e.g., pelvis bone PB in  FIGS.  9  and  12   ). The method  500  also includes the step  520  of attaching an expandable augment module to bone or to a fixed angle augment module that has been attached to bone (as shown in  FIGS.  9  and  12   ). The method  500  also includes the step  530  of adjusting the size of the expandable augment module to support (e.g., contact) the acetabular cup (e.g., as shown in  FIGS.  9  and  12   ). The method  500  also includes the step  540  of applying bone cement to secure the acetabular cup in bone and applying bone cement between plates of the expandable augment module (and between plates of the fixed angle augment module) to secure the acetabular cup assembly in place. 
     Additional Embodiments 
     In embodiments of the present disclosure, an augment system for an acetabular cup may be in accordance with any of the following clauses: 
     Clause 1. An expandable augment module for an acetabular cup, comprising: 
     a first plate configured to couple with a bone or a fixed augment module, the first plate having one or more first openings configured to receive therethrough corresponding one or more first fasteners, and   a second plate configured to couple to an outer surface of an acetabular cup, the second plate connected to the first plate and configured to pivot relative to the first plate between a first position where the second plate is proximate the first plate along its length and a second position where at least a portion of the second plate is spaced from the first plate, the second plate having one or more second openings configured to be coaxial with the one or more first openings when in the first position, the one or more second openings having a larger size than the one or more first openings.   

     Clause 2. The expandable augment module of clause 1, wherein the second plate is connected to the first plate by a living hinge. 
     Clause 3. The expandable augment module of any preceding clause, wherein the second plate is connected to the first plate by a hinge assembly that is separate from the first and second plates. 
     Clause 4. The expandable augment module of any preceding clause, wherein the second plate has an interface surface that interfaces with the outer surface of the acetabular cup, the interface surface being curved in a widthwise and lengthwise directions. 
     Clause 5. The expandable augment module of any preceding clause, wherein the first plate has an interface surface that interfaces with the bone or fixed augment module, the interface surface being curved in a widthwise and lengthwise directions. 
     Clause 6. The expandable augment module of any preceding clause, wherein the first plate has an interface surface that interfaces with the bone or fixed augment module, the interface surface being planar. 
     Clause 7. The expandable augment module of any preceding clause, wherein the first plate and second plate are interconnected by two or more support members movably coupled to each other and configured to move between a collapsed state in the first position and an expanded state in the second position, the support members configured to support the second plate in the second position and inhibit inadvertent movement of the second plate from said second position. 
     Clause 8. The expandable augment module of any preceding clause, wherein in the first position the expandable argument body has a thickness of approximately 5 mm. 
     Clause 9. The expandable augment module of any preceding clause, wherein in the second position the expandable augment body has a thickness of approximately 25 mm. 
     Clause 10. The expandable augment module of any preceding clause, further comprising the fixed augment module having a third plate and a fourth plate connected to the third plate and extending at a fixed angle relative to the third plate, the third plate having one or more openings configured to receive corresponding fasteners therethrough to couple the fixed augment module to bone, the fourth plate having one or more openings configured to receive the one or more first fasteners therethrough to couple the fixed augment module to the expandable augment body. 
     Clause 11. An augment kit for an acetabular cup, comprising:
     an expandable augment module comprising 
   a first plate having one or more first openings configured to receive therethrough corresponding one or more first fasteners, and   a second plate configured to couple to an outer surface of an acetabular cup, the second plate connected to the first plate and configured to pivot relative to the first plate between a first position where the second plate is proximate the first plate along its length and a second position where at least a portion of the second plate is spaced from the first plate, the second plate having one or more second openings configured to be coaxial with the one or more first openings when in the first position, the one or more second openings having a larger size than the one or more first openings; and   
   one or more fixed augment modules, each of the fixed augment modules having 
   a third plate, and   a fourth plate connected to the third plate and extending at a fixed angle relative to the third plate, the third plate having one or more openings configured to receive corresponding fasteners therethrough to couple the fixed augment module to bone, the fourth plate having one or more openings configured to receive the one or more first fasteners therethrough to couple the fixed augment module to the expandable augment body,   
   wherein at least one of the one or more fixed augment modules has a different fixed angle.   

     Clause 12. The kit of clause 11, wherein the second plate is connected to the first plate by a living hinge. 
     Clause 13. The kit of any of clauses 11-12, wherein the second plate is connected to the first plate by a hinge assembly that is separate from the first and second plates. 
     Clause 14. The kit of any of clauses 11-13, wherein the second plate has an interface surface that interfaces with the outer surface of the acetabular cup, the interface surface being curved in a widthwise and lengthwise directions. 
     Clause 15. The kit of any of clauses 11-14, wherein the first plate has an interface surface that interfaces with the bone or fixed augment module, the interface surface being curved in a widthwise and lengthwise directions. 
     Clause 16. The kit of any of clauses 11-15, wherein the first plate has an interface surface that interfaces with the bone or fixed augment module, the interface surface being planar. 
     Clause 17. The kit of any of clauses 11-16, wherein the first plate and second plate are interconnected by two or more support members movably coupled to each other and configured to move between a collapsed state in the first position and an expanded state in the second position, the support members configured to support the second plate in the second position and inhibit inadvertent movement of the second plate from said second position. 
     Clause 18. The kit of any of clauses 11-17, wherein in the first position the expandable argument body has a thickness of approximately 5 mm. 
     Clause 19. The kit of any of clauses 11-18, wherein in the second position the expandable augment body has a thickness of approximately 25 mm. 
     Clause 20. A method for implanting an acetabular cup, comprising:
     evaluating a size of an acetabular hole and one or more defects in a pelvis bone proximate the acetabulum;   attaching an expandable augment module of any preceding clause to the pelvis bone or to a fixed angle augment module attached to the pelvis bone;   adjusting a size of the expandable augment module to contact an acetabular cup; and   applying cement between the acetabular cup and bone, and applying cement between plates of the expandable augment module or plates of the fixed angled augment module to thereby fix the acetabular cup in the bone.   

     While certain embodiments of the inventions have been described, these embodiments have been presented by way of example only, and are not intended to limit the scope of the disclosure. Indeed, the novel methods and systems described herein may be embodied in a variety of other forms. Furthermore, various omissions, substitutions and changes in the systems and methods described herein may be made without departing from the spirit of the disclosure. The accompanying claims and their equivalents are intended to cover such forms or modifications as would fall within the scope and spirit of the disclosure. Accordingly, the scope of the present inventions is defined only by reference to the appended claims. 
     Features, materials, characteristics, or groups described in conjunction with a particular aspect, embodiment, or example are to be understood to be applicable to any other aspect, embodiment or example described in this section or elsewhere in this specification unless incompatible therewith. All of the features disclosed in this specification (including any accompanying claims, abstract and drawings), and/or all of the steps of any method or process so disclosed, may be combined in any combination, except combinations where at least some of such features and/or steps are mutually exclusive. The protection is not restricted to the details of any foregoing embodiments. The protection extends to any novel one, or any novel combination, of the features disclosed in this specification (including any accompanying claims, abstract and drawings), or to any novel one, or any novel combination, of the steps of any method or process so disclosed. 
     Furthermore, certain features that are described in this disclosure in the context of separate implementations can also be implemented in combination in a single implementation. Conversely, various features that are described in the context of a single implementation can also be implemented in multiple implementations separately or in any suitable subcombination. Moreover, although features may be described above as acting in certain combinations, one or more features from a claimed combination can, in some cases, be excised from the combination, and the combination may be claimed as a subcombination or variation of a subcombination. 
     Moreover, while operations may be depicted in the drawings or described in the specification in a particular order, such operations need not be performed in the particular order shown or in sequential order, or that all operations be performed, to achieve desirable results. Other operations that are not depicted or described can be incorporated in the example methods and processes. For example, one or more additional operations can be performed before, after, simultaneously, or between any of the described operations. Further, the operations may be rearranged or reordered in other implementations. Those skilled in the art will appreciate that in some embodiments, the actual steps taken in the processes illustrated and/or disclosed may differ from those shown in the figures. Depending on the embodiment, certain of the steps described above may be removed, others may be added. Furthermore, the features and attributes of the specific embodiments disclosed above may be combined in different ways to form additional embodiments, all of which fall within the scope of the present disclosure. Also, the separation of various system components in the implementations described above should not be understood as requiring such separation in all implementations, and it should be understood that the described components and systems can generally be integrated together in a single product or packaged into multiple products. 
     For purposes of this disclosure, certain aspects, advantages, and novel features are described herein. Not necessarily all such advantages may be achieved in accordance with any particular embodiment. Thus, for example, those skilled in the art will recognize that the disclosure may be embodied or carried out in a manner that achieves one advantage or a group of advantages as taught herein without necessarily achieving other advantages as may be taught or suggested herein. 
     Conditional language, such as “can,” “could,” “might,” or “may,” unless specifically stated otherwise, or otherwise understood within the context as used, is generally intended to convey that certain embodiments include, while other embodiments do not include, certain features, elements, and/or steps. Thus, such conditional language is not generally intended to imply that features, elements, and/or steps are in any way required for one or more embodiments or that one or more embodiments necessarily include logic for deciding, with or without user input or prompting, whether these features, elements, and/or steps are included or are to be performed in any particular embodiment. 
     Conjunctive language such as the phrase “at least one of X, Y, and Z,” unless specifically stated otherwise, is otherwise understood with the context as used in general to convey that an item, term, etc. may be either X, Y, or Z. Thus, such conjunctive language is not generally intended to imply that certain embodiments require the presence of at least one of X, at least one of Y, and at least one of Z. 
     Language of degree used herein, such as the terms “approximately,” “about,” “generally,” and “substantially” as used herein represent a value, amount, or characteristic close to the stated value, amount, or characteristic that still performs a desired function or achieves a desired result. For example, the terms “approximately”, “about”, “generally,” and “substantially” may refer to an amount that is within less than 10% of, within less than 5% of, within less than 1% of, within less than 0.1% of, and within less than 0.01% of the stated amount. As another example, in certain embodiments, the terms “generally parallel” and “substantially parallel” refer to a value, amount, or characteristic that departs from exactly parallel by less than or equal to 15 degrees, 10 degrees, 5 degrees, 3 degrees, 1 degree, or 0.1 degree. 
     The scope of the present disclosure is not intended to be limited by the specific disclosures of preferred embodiments in this section or elsewhere in this specification, and may be defined by claims as presented in this section or elsewhere in this specification or as presented in the future. The language of the claims is to be interpreted broadly based on the language employed in the claims and not limited to the examples described in the present specification or during the prosecution of the application, which examples are to be construed as non-exclusive. 
     Of course, the foregoing description is that of certain features, aspects and advantages of the present invention, to which various changes and modifications can be made without departing from the spirit and scope of the present invention. Moreover, the devices described herein need not feature all of the objects, advantages, features and aspects discussed above. Thus, for example, those of skill in the art will recognize that the invention can be embodied or carried out in a manner that achieves or optimizes one advantage or a group of advantages as taught herein without necessarily achieving other objects or advantages as may be taught or suggested herein. In addition, while a number of variations of the invention have been shown and described in detail, other modifications and methods of use, which are within the scope of this invention, will be readily apparent to those of skill in the art based upon this disclosure. It is contemplated that various combinations or subcombinations of these specific features and aspects of embodiments may be made and still fall within the scope of the invention. Accordingly, it should be understood that various features and aspects of the disclosed embodiments can be combined with or substituted for one another in order to form varying modes of the discussed devices.