Survivorship and Patient Outcomes of Conforming Bearings in Modern Primary Total Knee Arthroplasty: Mean 3.5 Year Follow-Up.

BACKGROUND: Conforming and congruent bearings in total knee arthroplasty (TKA) have rapidly increased due to the benefits of increased stability and the potential for replicating normal knee kinematics. However, limited data exist for these newly available bearings. This study evaluated revision-free survivorship and patient-reported outcome measures (PROMs) of a large granular database of primary TKAs using a single conforming bearing design. METHODS: A total of 1,306 consecutive primary TKAs performed using a single conforming bearing design (85% cemented and 15% cementless) were retrospectively reviewed. Kaplan-Meier (KM) survivorship estimates were calculated based on the latest clinical follow-up. The PROMs and minimal clinically important differences (MCIDs) were evaluated. A total of 93% of cases achieved minimum 1-year clinical follow-up (mean 3.5 years; range, 1 to 7), with a subset of 261 cases that achieved minimum 5-year follow-up (mean 5.8 years; range, 5 to 7). RESULTS: All-cause and aseptic KM survivorship estimates were 97.6 (95% CI [confidence interval], 97 to 99) and 98.1% (95% CI, 97 to 99) at 7.0 years. Revision-free survivorship did not differ by cemented or cementless fixation (98 versus 97%, P = 0.163). All PROM scores significantly improved from preoperative baseline (P < 0.001), and ≥ 86% of patients achieved MCIDs for Knee Society pain and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) total scores. A total of 89% of cases reported their knees to 'sometimes or always' feel normal. For cases with minimum 5-year PROMs, 93% were 'very satisfied' or 'satisfied.' CONCLUSION: Conforming-bearing TKA demonstrated excellent survivorship up to 7.0 years. In addition, PROMs were comparable to other designs reported in the literature. While mid-term (mean 3.5-year) results are promising, long-term data are warranted on survivorship due to potential polyethylene wear in conforming bearings with more surface area in contact with articulating surfaces.

The potential of electrodialysis as a cost-effective alternative to reverse osmosis for brackish water desalination.

While electrodialysis (ED) demonstrates lower energy consumption than reverse osmosis (RO) in the desalination of low salinity waters, RO continues to be the predominant technology for brackish water desalination. In this study, we probe this skewed market share and project the potential for future disruption by ED through systematic assessment of the levelized cost of water (LCOW). Using rigorous process- and economic-models, we minimize the LCOW of RO and ED systems, highlighting important tradeoffs between capital and operating expenditure for each technology. With optimized current state-of-the-art systems, we find that ED is more economical than RO for feed salinities ≤ 3 g L-1, albeit to a minor extent. Considering that RO is a highly mature technology, we focus on predicting the future potential of ED by evaluating plausible avenues for capital and operating cost reduction. Specifically, we find that reduction in the price of ion-exchange membranes (i.e., < 60 USD m-2) can ensure competitiveness with RO for feed salinities up to 5 g L-1. For higher feed salinities (≥ 5 g L-1) we reveal that the LCOW of ED may effectively be reduced by decreasing ion-exchange membrane resistance, while preserving high current efficiency. Through extensive assessment of structure-property-performance relationships, we precisely identify target membrane charge densities and diffusion coefficients which optimize the LCOW of ED, thus providing novel guidance for future membrane material development. Overall, we emphasize that with a unified approach - whereby ion-exchange membrane price is reduced and performance is enhanced - ED can become the economically preferable technology compared to RO across the entire brackish water salinity range.

Rapid, Selective, and Chemical-Free Removal of Dissolved Silica from Water via Electrosorption: Feasibility and Mechanisms.

The unavoidable and detrimental formation of silica scale in engineered processes necessitates the urgent development of effective, economic, and sustainable strategies for dissolved silica removal from water. Herein, we demonstrate a rapid, chemical-free, and selective silica removal method using electrosorption. Specifically, we confirm the feasibility of exploiting local pH dynamics at the electrodes in flow-through electrosorption, achieved through a counterintuitive cell configuration design, to induce ionization and concomitant electrosorption of dissolved silica. In addition, to improve the feasibility of silica electrosorption under high-salinity solutions, we developed a silica-selective anode by functionalizing porous activated carbon cloths with aluminum hydroxide nanoparticles (Al(OH)3-p-ACC). The modification markedly enhances silica sorption capacity (2.8 vs 1.1 mgsilica ganode-1) and reduces the specific energy consumption (13.3 vs 19.8 kWh kgsilica-1). Notably, the modified electrode retains remarkable silica sorption capacity even in the presence of high concentrations of co-occurring ions (up to 100 mM NaCl). The mechanisms underlying the superior silica removal stability and selectivity with the Al(OH)3-p-ACC electrode are also elucidated, revealing a synergistic interaction involving outer-sphere and inner-sphere complexation between dissolved silica and Al(OH)3 nanoparticles on the electrodes. Moreover, we find that effective regeneration of the electrodes may be achieved by applying a reverse potential during discharge, although complete regeneration of the modified electrodes may necessitate alternative materials or process optimization. We recommend the adoption of feedwater-specific designs for the development of future silica-selective electrodes in electrosorption capable of meeting silica removal demands across a wide range of engineered systems.

Origin of Limiting and Overlimiting Currents in Bipolar Membranes.

Bipolar membranes (BPMs), a special class of ion exchange membranes with the unique ability to electrochemically induce either water dissociation or recombination, are of growing interest for environmental applications including eliminating chemical dosage for pH adjustment, resource recovery, valorization of brines, and carbon capture. However, ion transport within BPMs, and particularly at its junction, has remained poorly understood. This work aims to theoretically and experimentally investigate ion transport in BPMs under both reverse and forward bias operation modes, taking into account the production or recombination of H+ and OH-, as well as the transport of salt ions (e.g., Na+, Cl-) inside the membrane. We adopt a model based on the Nernst-Planck theory, that requires only three input parameters─membrane thickness, its charge density, and pK of proton adsorption─to predict the concentration profiles of four ions (H+, OH-, Na+, and Cl-) inside the membrane and the resulting current-voltage curve. The model can predict most of the experimental results measured with a commercial BPM, including the observation of limiting and overlimiting currents, which emerge due to particular concentration profiles that develop inside the BPM. This work provides new insights into the physical phenomena in BPMs and helps identify optimal operating conditions for future environmental applications.

Electrosorption Integrated with Bipolar Membrane Water Dissociation: A Coupled Approach to Chemical-free Boron Removal.

Boron removal from aqueous solutions has long persisted as a technological challenge, accounting for a disproportionately large fraction of the chemical and energy usage in seawater desalination and other industrial processes like lithium recovery. Here, we introduce a novel electrosorption-based boron removal technology with the capability to overcome the limitations of current state-of-the-art methods. Specifically, we incorporate a bipolar membrane (BPM) between a pair of porous carbon electrodes, demonstrating a synergized BPM-electrosorption process for the first time. The ion transport and charge transfer mechanisms of the BPM-electrosorption system are thoroughly investigated, confirming that water dissociation in the BPM is highly coupled with electrosorption of anions at the anode. We then demonstrate effective boron removal by the BPM-electrosorption system and verify that the mechanism for boron removal is electrosorption, as opposed to adsorption on the carbon electrodes or in the BPM. The effect of applied voltage on the boron removal performance is then evaluated, revealing that applied potentials above ∼1.0 V result in a decline in process efficiency due to the increased prevalence of detrimental Faradaic reactions at the anode. The BPM-electrosorption system is then directly compared with flow-through electrosorption, highlighting key advantages of the process with regard to boron sorption capacity and energy consumption. Overall, the BPM-electrosorption shows promising boron removal capability, with a sorption capacity >4.5 µmol g-C-1 and a corresponding specific energy consumption of <2.5 kWh g-B-1.

Effect of Tobacco Use on Radiolucent Lines in Modern Cementless Total Knee Arthroplasty Tibial Components.

Background: The link between tobacco consumption and wound complications following total knee arthroplasty (TKA) is well established. However, the effect of tobacco use on biologic fixation in cementless TKA remains unknown. This study evaluated the influence of tobacco use on the presence of radiolucent lines of tibial components in cementless TKA. Methods: A total of 293 consecutive cementless TKAs of 2 contemporary designs were retrospectively reviewed. Tibial radiolucent lines and component alignment were measured using an established measurement protocol. Patients with any history of tobacco use or active tobacco use (tobacco users) were compared to those with no history of tobacco use (tobacco nonusers). No significant differences which influenced outcomes were detected between the tobacco user and tobacco nonuser groups (P ≥ .071). Results: Radiolucent lines decreased from 1-month to latest follow-up (mean 2.5 years) in all 10 radiographic zones regardless of tobacco use (P ≤ .084). However, evaluating intrapatient change in radiolucent line width, the tobacco nonuser group had more radiolucent lines resolve by the latest follow-up in nearly all radiographic zones, although most differences did not reach statistical significance, except for anteroposterior zone 1 (-31% vs -19%, P = .022). No tibial components were revised for aseptic loosening. Conclusions: Results from this study suggest that any tobacco use prior to cementless TKA has the potential to hinder biologic fixation of tibial components. While no tibial components were revised for aseptic loosening, follow-up was relatively short at 2.5 years and therefore warrants further study to discern the effect of persistent radiolucent lines on long-term fixation.

Mining Nontraditional Water Sources for a Distributed Hydrogen Economy.

Securing decarbonized economies for energy and commodities will require abundant and widely available green H2. Ubiquitous wastewaters and nontraditional water sources could potentially feed water electrolyzers to produce this green hydrogen without competing with drinking water sources. Herein, we show that the energy and costs of treating nontraditional water sources such as municipal wastewater, industrial and resource extraction wastewater, and seawater are negligible with respect to those for water electrolysis. We also illustrate that the potential hydrogen energy that could be mined from these sources is vast. Based on these findings, we evaluate the implications of small-scale, distributed water electrolysis using disperse nontraditional water sources. Techno-economic analysis and life cycle analysis reveal that the significant contribution of H2 transportation to costs and CO2 emissions results in an optimal levelized cost of hydrogen at small- to moderate-scale water electrolyzer size. The implications of utilizing nontraditional water sources and decentralized or stranded renewable energy for distributed water electrolysis are highlighted for several hydrogen energy storage and chemical feedstock applications. Finally, we discuss challenges and opportunities for mining H2 from nontraditional water sources to achieve resilient and sustainable economies for water and energy.

Nanopore-Based Power Generation from Salinity Gradient: Why It Is Not Viable.

In recent years, the development of nanopore-based membranes has revitalized the prospect of harvesting salinity gradient (blue) energy. In this study, we systematically analyze the energetic performance of nanopore-based power generation (NPG) at various process scales, beginning with a single nanopore, followed by a multipore membrane coupon, and ending with a full-scale system. We confirm the high power densities attainable by a single nanopore and demonstrate that, at the coupon scale and above, concentration polarization severely hinders the power density of NPG, revealing the common, yet significant, error in linearly extrapolating single-pore performance to multipore membranes. Through our consideration of concentration polarization, we also importantly show that the development of materials with exceptional nanopore properties provides limited enhancement of practical process performance. For a full-scale NPG membrane module, we find an inherent tradeoff between power density and thermodynamic energy efficiency, whereby achieving a high power density sacrifices the energy efficiency. Furthermore, we derive a simple expression for the theoretical maximum energy efficiency of NPG, showing it is solely related to the membrane selectivity (i.e., S2/2). Through this relation, it is apparent that the energy efficiency of NPG is limited to only 50% (for a completely selective membrane, i.e., S = 1), reinforcing our optimistic full-scale simulations which result in a (practical) maximum energy efficiency of 42%. Finally, we assess the net extractable energy of a full-scale NPG system which mixes river water and seawater by including the energy losses from pretreatment and pumping, revealing that the NPG process-both in its current state of development and in the case of highly optimistic performance with minimized external energy losses-is not viable for power generation.

Energy Efficiency of Electro-Driven Brackish Water Desalination: Electrodialysis Significantly Outperforms Membrane Capacitive Deionization.

Electro-driven technologies are viewed as a potential alternative to the current state-of-the-art technology, reverse osmosis, for the desalination of brackish waters. Capacitive deionization (CDI), based on the principle of electrosorption, has been intensively researched under the premise of being energy efficient. However, electrodialysis (ED), despite being a more mature electro-driven technology, has yet to be extensively compared to CDI in terms of energetic performance. In this study, we utilize Nernst-Planck based models for continuous flow ED and constant-current membrane capacitive deionization (MCDI) to systematically evaluate the energy consumption of the two processes. By ensuring equivalently sized ED and MCDI systems-in addition to using the same feed salinity, salt removal, water recovery, and productivity across the two technologies-energy consumption is appropriately compared. We find that ED consumes less energy (has higher energy efficiency) than MCDI for all investigated conditions. Notably, our results indicate that the performance gap between ED and MCDI is substantial for typical brackish water desalination conditions (e.g., 3 g L-1 feed salinity, 0.5 g L-1 product water, 80% water recovery, and 15 L m-2 h-1 productivity), with the energy efficiency of ED often exceeding 30% and being nearly an order of magnitude greater than MCDI. We provide further insights into the inherent limitations of each technology by comparing their respective components of energy consumption, and explain why MCDI is unable to attain the performance of ED, even with ideal and optimized operation.