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Lyme Prosthetic Joint Infection in Total Knee Arthroplasty: A Case Report

Muzaffar Ali1, Anthony O Kamson1, Nadia Hussain2

  • 1UPMC Pinnacle, Harrisburg, Pennsylvania.

JBJS Case Connector
|July 30, 2021
PubMed
Abstract

Insights

Lyme disease can cause late prosthetic joint infections (PJIs) years after surgery. Early surgical intervention for Borrelia burgdorferi PJI may improve outcomes, but neuroborreliosis remains a risk.

Area of Science:

  • Infectious Diseases
  • Orthopedic Surgery
  • Rheumatology

Background:

  • Prosthetic joint infections (PJIs) are serious complications of joint replacement surgery.
  • Culture-negative PJIs can be challenging to diagnose and treat.
  • Borrelia burgdorferi, the causative agent of Lyme disease, can lead to late-onset infections.

Observation:

  • An 81-year-old man developed an acute Borrelia burgdorferi prosthetic joint infection (PJI) 15 years post-right total knee arthroplasty.
  • The patient presented with symptoms indicative of Lyme disease affecting his prosthetic joint.
  • Diagnostic tests, including synovial fluid Lyme polymerase chain reaction and serology, were positive for Borrelia burgdorferi.

Findings:

  • The patient underwent irrigation and debridement with implant retention.
  • Post-operative treatment with oral doxycycline resulted in initial asymptomatic recovery at 6 weeks.
  • Tragically, the patient succumbed to neuroborreliosis vasculitis, a severe complication of Lyme disease, four months later.

Implications:

  • Lyme disease should be considered in the differential diagnosis of culture-negative PJIs, especially in regions where Borrelia burgdorferi is endemic.
  • Prompt surgical management of Lyme-related PJIs may be crucial in preventing severe sequelae.
  • This case highlights the potential for late-onset Lyme complications and the critical need for timely diagnosis and treatment.

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