Lyme Arthritis After Surgery: When It Mimics Joint Infection
The surgery was successful.
But the pain and swelling returned.
This is where Lyme disease can be missed.
Lyme arthritis after surgery can present as persistent joint pain and swelling—sometimes mimicking prosthetic joint infection (PJI) or other postoperative complications.
This is where postoperative complications can be misdiagnosed.
This is where one diagnosis can overshadow another.
In a report by Hess and colleagues, five cases were described in which patients developed Lyme arthritis following orthopedic procedures.
This is part of a broader pattern of Lyme disease mimicking orthopedic conditions.
Start here: Lyme disease symptoms guide
See also: Lyme arthritis
Can Lyme Arthritis Occur After Surgery?
What happens when joint symptoms return after an operation?
Postoperative pain and swelling are often attributed to infection, inflammation, or mechanical failure.
This is where Lyme disease may not be considered.
However, in Lyme-endemic areas, Lyme arthritis can present in a similar way—leading to delayed diagnosis.
Lyme arthritis is a well-recognized manifestation of late-stage infection.
What Happened in These Cases?
How did Lyme arthritis present after surgery?
Across these cases, a consistent pattern emerged.
- Case 1: A 38-year-old woman developed arthritis after ACL reconstruction and cartilage repair. She improved with oral amoxicillin, although graft failure occurred months later and was attributed to infection.
- Case 2: A 67-year-old man developed progressive knee pain and swelling 12 months after unicompartmental knee arthroplasty. He recovered after 6 weeks of intravenous ceftriaxone.
- Case 3: An 83-year-old man presented with fever and joint effusion 6 years after total knee replacement. He improved with doxycycline and intravenous ceftriaxone.
- Cases 4 & 5: Two elderly women presented with knee pain, swelling, and stiffness following total knee arthroplasty. Both were ultimately diagnosed with Lyme arthritis.
These cases highlight how Lyme disease can present long after surgery—and mimic other conditions.
Why Might Lyme Arthritis Appear After Surgery?
This is where mechanisms are still being explored.
The authors proposed several possible explanations:
- Persistent infection: Borrelia burgdorferi may evade eradication and remain dormant in joint tissue.
- Immune changes: Surgical stress or immune activation may trigger symptoms from previously silent infection.
- Biofilm-related infection: The organism may contribute to prosthetic joint infection through biofilm formation.
This is where Lyme disease may behave differently than typical bacterial infections.
Why This Matters for Diagnosis
What should clinicians consider?
In patients with persistent or unexplained joint symptoms after surgery, Lyme disease may not be immediately suspected.
This is where important diagnoses can be missed.
Lyme arthritis can resemble:
- Prosthetic joint infection (PJI)
- Mechanical failure
- Postoperative inflammation
This overlap can delay appropriate treatment.
See related discussion: Lyme disease mimicking prosthetic joint infection
Clinical Takeaway
Lyme arthritis can develop after orthopedic procedures and may mimic postoperative complications.
In Lyme-endemic areas, it should be considered in patients with persistent joint pain and swelling after surgery.
If joint symptoms don’t follow the expected postoperative course, it’s worth asking why—again.
Related Reading
- Steroid injections and Lyme arthritis
- Treatment of Lyme arthritis after knee surgery
- Lyme disease mimics prosthetic joint infection
References
- Hess, M. C., Devilbiss, Z., Ho, G. W. K., & Thal, R. (2019). Postoperative Lyme arthritis in the orthopaedic patient. Sports Health. https://doi.org/10.1177/1941738119845671
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.