Lyme Disease and Prosthetic Joint Infection After Knee Replacement
A WOMAN DEVELOPED PAIN AND SWELLING YEARS AFTER KNEE REPLACEMENT
TESTING EVENTUALLY IDENTIFIED BORRELIA BURGDORFERI
AS THE CAUSE OF A CULTURE-NEGATIVE JOINT INFECTION
Lyme disease prosthetic joint infection is rare but increasingly recognized in endemic regions. This case highlights how Borrelia burgdorferi may present as a culture-negative prosthetic joint infection years after knee replacement surgery.
The 68-year-old woman presented to the orthopedic clinic with pain and swelling in her right knee, which had been ongoing for 2 weeks.
Eight years earlier, she had undergone total knee replacement and had remained pain free following surgery.
One month prior to her knee pain, the patient had been treated with steroids for pain in her right hip.
In the preceding 4 months, she had also visited her primary care doctor complaining of fatigue. But she did not recall any tick bites or a rash.
According to the authors, the woman had elevated serum inflammatory markers and culture-negative aspirate with a high percentage of neutrophils.
“The patient underwent a standard prosthesis explant procedure, followed by the placement of an articulating antibiotic spacer.”
She was treated empirically with a 6-week course of IV vancomycin and ceftriaxone.
However, “Given her residence in a rural setting and frequent walks with her dogs in wooded settings,” Lyme disease testing was performed.
Test results were positive for Lyme by IgG and IgM, and she began treatment with IV doxycycline.
“One week after the first-stage explant, B. burgdorferi was determined to be the causative microorganism.”
The second stage of her knee surgery was performed and after 1 year, the woman had no signs or symptoms of infection.
Why Lyme Disease Prosthetic Joint Infection Can Be Missed
Lyme disease prosthetic joint infection may resemble more common bacterial prosthetic joint infections while remaining culture negative.
Patients may present with:
- Joint swelling
- Pain
- Elevated inflammatory markers
- Negative routine cultures
Absence of a known tick bite or rash may further complicate recognition.
Clinical Perspective
This case highlights the importance of considering Lyme arthritis and tick-borne infection in patients with unexplained culture-negative prosthetic joint infections, particularly in endemic areas.
Symptoms may initially resemble mechanical failure, inflammatory arthritis, or routine bacterial infection.
Testing for Lyme disease may be appropriate in select patients with unexplained prosthetic joint inflammation and environmental exposure risk.
Authors Conclude
- “B. burgdorferi as a cause for culture negative [prosthetic joint infections] should be a consideration for those patients in endemic areas, with or without known tick exposure.”
Clinical Takeaway
Lyme disease prosthetic joint infection is uncommon but may occur years after joint replacement surgery.
In endemic regions, Lyme disease may deserve consideration in patients with culture-negative prosthetic joint infections and persistent inflammation.
Related Articles
Lyme disease mimics prosthetic joint infection following knee replacement
Will steroid injections help children with Lyme arthritis of the knee?
Treatment of Lyme arthritis after knee surgery
References
- Crowe M, Giacobazzi M, Griffin E, Storm S. Borrelia burgdorferi-A Bacterium Worthy of Consideration in Culture-Negative Prosthetic Joint Infection. J Am Acad Orthop Surg Glob Res Rev. 2023 Sep 14;7(9):e23.00068. doi: 10.5435/JAAOSGlobal-D-23-00068. PMID: 37707984; PMCID: PMC10503676.
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
I find misdiagnosed sepsis as a suspected Bb infection in those I suspect Tick diseases infected in my research.
There are multiple potential causes to consider whenever Lyme disease is included in an evaluation.
I’m very curious, I have chronic Lyme going on 23 years. In March I underwent a Meniscus repair, rehab have been much slower than I expected. The surgeon had given me two cortisone injections to “relieve swelling and pain. ”
Can my Lyme be causing the issues with my recovery?
Lyme disease is a common cause of knee synovitis. I advise my patients to include a Lyme disease evaluation.