Lyme Arthritis After Knee Surgery: 5 Postoperative Cases
Postoperative knee pain may have multiple causes
Lyme arthritis can occasionally mimic surgical complications or infection
Recognition may help avoid delays in diagnosis and treatment
Lyme arthritis after knee surgery may be difficult to recognize because postoperative pain, swelling, and stiffness are often initially attributed to surgical recovery or prosthetic complications. Hess and colleagues discuss five reported cases involving postoperative Lyme arthritis following orthopedic procedures.1
These reports highlight an important challenge for clinicians in endemic regions: Lyme arthritis may occasionally resemble postoperative infection or periprosthetic joint infection (PJI).
Case 1: Lyme arthritis following knee reconstruction surgery
The first case involved a 38-year-old woman who had undergone knee surgery including a bone-patellar tendon-bone reconstruction of the anterior cruciate ligament along with staged autologous chondrocyte transplantation to repair a traumatic cartilage lesion. She received oral amoxicillin (500 mg three times daily for 3 weeks) and reported improvement of her arthritis symptoms. However, graft failure three months later was reported to be secondary to infection.1
See also Lyme disease symptoms guide.
Cases 2–5: Lyme arthritis mimicking prosthetic joint infection
The authors describe four additional cases in which Lyme arthritis presented similarly to periprosthetic joint infection (PJI).1
Case 2: A 67-year-old man developed progressive knee pain and swelling over three months. Twelve months earlier, he had undergone unicompartmental joint arthroplasty of the same knee and later recovered after six weeks of intravenous ceftriaxone treatment.1
Case 3: An 83-year-old man presented with fever and moderate joint effusion six years after total knee arthroplasty. His symptoms resolved following doxycycline and intravenous ceftriaxone treatment.1
Cases 4 and 5: An 89-year-old woman developed knee pain, swelling, and stiffness six years after total knee arthroplasty. Another patient, an 80-year-old woman, presented four months after arthroplasty with anterior proximal tibia erythema and tenderness. Both were ultimately diagnosed with Lyme arthritis.1
See also Persistent Lyme disease symptoms.
Why might Lyme arthritis appear after surgery?
The authors considered three potential explanations for postoperative Lyme arthritis:
- “The spirochete, at times, evades complete eradication and lies dormant in host tissue, most notably joint, nervous, and cutaneous sites in humans.”
- “Alterations to immune surveillance as a result of surgery or mechanical exposure of dormant B. burgdorferi spirochetes during surgery with influx of immune cells into the joint are possible explanations for such a condition.”
- Lyme arthritis periprosthetic joint infection (PJI) is also possible and may be related to B. burgdorferi’s biofilm formation.
This overlap may complicate postoperative evaluation because symptoms of Lyme arthritis and prosthetic joint infection can appear similar.1
Frequently Asked Questions
Can Lyme arthritis occur after knee surgery?
Rare reports suggest Lyme arthritis may occasionally appear after orthopedic procedures, particularly in endemic regions.
Can Lyme arthritis mimic prosthetic joint infection?
Yes. Lyme arthritis may present with pain, swelling, effusions, and inflammatory findings similar to prosthetic joint infection.
Do patients with postoperative Lyme arthritis recover?
Published case reports describe improvement after antibiotic treatment, though recovery may vary depending on timing and severity.
Should Lyme disease be considered after orthopedic surgery?
In endemic regions, Lyme disease may deserve consideration when postoperative symptoms remain unexplained.
Clinical Takeaway
Postoperative pain and swelling after orthopedic procedures do not always represent mechanical failure or bacterial infection.
Clinicians practicing in endemic regions may need to consider Lyme arthritis when evaluating unexplained postoperative joint symptoms.
Related Articles
Will steroid injections help children with Lyme arthritis of the knee
Successful treatment of Lyme arthritis after knee surgery
Lyme disease mimics prosthetic joint infection following knee replacement
Lyme arthritis in the hands
References
- Hess MC, Devilbiss Z, Ho GWK, Thal R. Postoperative Lyme Arthritis in the Orthopaedic Patient. Sports Health. 2019:1941738119845671.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
Dear Dr. Cameron,
The first diagnosis I received in regards to my maladies was Hashimoto’s Thyroiditis, 1986. Followed by Endometriosis, 2003, CFS 2006, Adnomyosis 2006 (full hysterectomy 06/2006) never recovered. 2012 hospitalized for 10 days, 2.3 Hemoglobin. Received 50 Blood Transfusions, still no diagnosis. 17 Root Canals, all failed. Tonsillectomy 2013. Finally 08/2013 tested for Bb, Western Blot ~ Positive for Lyme Disease. 2013 w/Dr. R. Stricker testing & treatment for Bb pos, Babesia pos, Ehrlichia pos. via IGeneX. Presently still displaying symptoms. Testing w/Internist via Quest Diagnostics. New results as follows: LYME AB SCREEN
View trends Index value >0.90. My Question: Do I or should I request additional testing?? Per Website: If Lyme Disease Antibody Screen is ≥0.90, then Lyme Disease Antibodies (IgG, IgM), Immunoblot will be performed at an additional charge (CPT code(s): 86617 x2). I do not believe an Immunoblot was ordered or performed. Your thoughts? Which direction should I proceed? Should tests be performed through IGeneX? My state is governed by IDSA Rules and Regulations. Thank you, Dr. Cameron, you are a blessing and a hero to so many.