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Lyme Prosthetic Joint Infection May Be Underappreciated and Can Be Treated Without Surgery: A Case Report

Andy O Miller1, Alberto V Carli, Cynthia Kahlenberg

  • 1Hospital of Special Surgery, New York, New York.

JBJS Case Connector
|February 20, 2025
PubMed
Abstract

Insights

Lyme disease can cause periprosthetic joint infections (PJI) that are difficult to diagnose with standard cultures. This case shows successful treatment of Lyme PJI with antibiotics alone, avoiding surgery.

Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Medical Diagnostics

Background:

  • Periprosthetic joint infection (PJI) is a serious complication following joint replacement surgery.
  • Culture-negative PJI presents diagnostic challenges, potentially delaying appropriate treatment.
  • Lyme disease, caused by Borrelia burgdorferi, is an emerging consideration in infectious disease diagnostics.

Purpose of the Study:

  • To highlight Lyme disease as an underrecognized cause of culture-negative periprosthetic joint infection (PJI).
  • To present a case demonstrating successful non-surgical management of Lyme PJI.
  • To emphasize the importance of considering Lyme serology and PCR in specific PJI cases.

Main Methods:

  • A case study of a 68-year-old woman with a total knee replacement presenting with PJI symptoms.
  • Diagnostic workup included Lyme serology and synovial fluid PCR to investigate Borrelia burgdorferi.
  • Treatment involved a course of oral doxycycline.

Main Results:

  • The patient exhibited prompt resolution of PJI symptoms following antibiotic treatment.
  • The patient remained asymptomatic with a functioning knee replacement at a 2-year follow-up.
  • This suggests a successful non-surgical outcome for Lyme PJI.

Conclusions:

  • Lyme PJI is a potentially underdiagnosed cause of culture-negative PJI.
  • Standard cultures may fail to detect Borrelia burgdorferi in PJI.
  • Non-surgical treatment with antibiotics can be effective for Lyme PJI, avoiding the need for revision surgery.

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