Open AccessAn Insight Into Lyme Prosthetic Joint Infection in Knee Arthroplasty: A Literature Review
Author(s) -
Muzaffar Ali,
Anthony O. Kamson,
David S. Phillips,
Scott G King
Publication year - 2022
Publication title -
journal of the american academy of orthopaedic surgeons. global research and reviews
Language(s) - English
Resource type - Journals
ISSN - 2474-7661
DOI - 10.5435/jaaosglobal-d-21-00191
Subject(s) - medicine , lyme disease , antibiotics , lyme , asymptomatic , serology , arthroplasty , surgery , intensive care medicine , borrelia burgdorferi , immunology , antibody , biology , microbiology and biotechnology
Lyme prosthetic joint infection (PJI) is a rare event, but it is imperative to include Lyme disease as a possible cause of PJI in a Lyme-endemic region. The purpose of this article was to review the reported cases of Lyme PJIs in knee arthroplasty and to initiate the development of a treatment strategy. We found five cases of Lyme PJI in the literature. All patients lived in the northeastern region of the United States. Four patients were successfully treated with surgical intervention and postoperative antibiotics. One patient was successfully treated with intravenous and oral antibiotics for 6 weeks, without surgical intervention. Synovial fluid Lyme polymerase chain reaction and serological tests were positive in all patients. On follow-up visits, after completion of their treatment, all patients were asymptomatic with a painless functional knee. We recommend considering Lyme disease as a cause of culture-negative PJIs in endemic regions. Additional research is needed to clearly define a treatment algorithm. Based on our literature review, we cannot recommend a single best treatment modality for the treatment of Lyme PJI. However, early irrigation and débridement with administration of postoperative antibiotics may improve early clinical outcomes.