Lyme Disease Mimics Prosthetic Joint Infection After Knee Replacement
Culture-negative joint infections can complicate diagnosis.
Lyme disease may mimic prosthetic joint infection.
Recognition may prevent unnecessary surgery.
Lyme disease can mimic prosthetic joint infection, leading to delayed diagnosis and unnecessary surgery.
The 83-year-old man, from Pennsylvania, was admitted to the hospital reporting knee pain, erythema, and fever for 3 days.
Upon examination, physicians noted he had “a moderate effusion and limited range of motion,” explains Collins.
The patient had undergone total knee replacement involving the same knee 6 years earlier.
Culture-Negative Prosthetic Joint Infection Suspected
Culture tests were negative for bacterial infection.
However, the patient still met Musculoskeletal Infection Society criteria for periprosthetic joint infection (PJI).
As a result, the prosthetic knee was removed.
“The patient underwent resection arthroplasty with insertion of a static antibiotic spacer, as purulence and synovitis were noted intraoperatively,” writes Collins in the Journal of the American Academy of Orthopedic Surgeons.
The patient was prescribed 6 weeks of intravenous antibiotics.
Lyme Disease Testing Confirmed Disseminated Infection
Following surgery, Lyme disease testing results became available.
Both Lyme antibody testing and synovial fluid Lyme PCR were positive.
Lyme IgG testing was also positive, with the presence of 8 of 10 significant bands (18, 23, 28, 30, 39, 41, 58, and 66 kDa).
The patient’s diagnosis was changed to disseminated Lyme disease.
Improvement After Lyme Disease Treatment
His symptoms improved after treatment with:
- 2 weeks of oral doxycycline
- 4 weeks of intravenous ceftriaxone
“He subsequently underwent removal of the antibiotic cement spacer and reimplantation using revision TKA components,” writes Collins.
Why This Case Matters
The authors stress the importance of considering Lyme disease in patients with total knee replacement whose presentation suggests culture-negative prosthetic joint infection.
Recognition of Lyme arthritis in these settings may help avoid unnecessary surgery and prolonged exposure to broad-spectrum antibiotics.
“Early and definitive diagnosis of Lyme-associated PJI will allow for the timely initiation of targeted antimicrobial therapy, which will reduce the need for prolonged broad spectrum antibiotics, and thus may reduce the risk of antibiotic resistance,” the authors conclude.
Clinical Takeaway
Lyme disease should remain part of the differential diagnosis in patients with culture-negative prosthetic joint infection, particularly in endemic regions.
Large joint effusions, persistent inflammation, and negative cultures may warrant additional evaluation for Lyme disease.
Related Articles:
Successful treatment of Lyme arthritis after knee surgery
Preventing unnecessary surgery for children with Lyme arthritis
References:
- Collins KA, Gotoff JR, Ghanem ES. Lyme Disease: A Potential Source for Culture-negative Prosthetic Joint Infection. J Am Acad Orthop Surg Glob Res Rev. 2017;1(5):e023.
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
