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An Insight Into Lyme Prosthetic Joint Infection in Knee Arthroplasty: A Literature Review
Muzaffar Ali1, Anthony O Kamson, David S Phillips
1From the University of Pittsburgh Medical Center-Pinnacle (Dr. Ali, Dr. Kamson, Dr. Phillips, Dr. King), Harrisburg, PA, and the UPMC Pinnacle-Arlington Orthopedics (Dr. King), Harrisburg, PA.
Summary
Lyme prosthetic joint infection (PJI) is rare but should be considered in endemic areas. Early treatment with surgery and antibiotics, or antibiotics alone, can lead to successful outcomes for patients with Lyme PJI.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Rheumatology
Background:
- Lyme prosthetic joint infection (PJI) is an uncommon complication following knee arthroplasty.
- Diagnosis can be challenging, especially in culture-negative cases within Lyme-endemic regions.
Purpose of the Study:
- To review reported cases of Lyme PJI in knee arthroplasty.
- To contribute to the development of a treatment strategy for this condition.
Main Methods:
- Literature review of reported cases of Lyme PJI in knee arthroplasty.
- Analysis of patient demographics, treatment modalities, and clinical outcomes.
Main Results:
- Five cases of Lyme PJI in knee arthroplasty were identified, all in the northeastern United States.
- Four patients achieved successful outcomes with surgical intervention and antibiotics; one was treated successfully with antibiotics alone.
- Positive synovial fluid Lyme polymerase chain reaction and serological tests were noted in all cases.
Conclusions:
- Lyme disease should be considered in the differential diagnosis of culture-negative PJIs in endemic areas.
- While a definitive treatment algorithm is lacking, early irrigation and débridement with postoperative antibiotics may improve outcomes.
- Further research is necessary to establish optimal treatment guidelines for Lyme PJI.
