Lyme in the prosthetic joint: two cases and a review of the literature

Abstract. Lyme periprosthetic joint infection (PJI) is rare, with only 8 cases reported in the literature. In this paper, we describe 2 cases and review the prior 8 cases to better characterize its diagnosis and management. All 10 cases presented with culture-negative PJI in Lyme-endemic regions and were confirmed to have Lyme PJI via a positive Borrelia-targeted polymerase chain reaction (PCR) run on joint specimens. Treatment strategies varied: 5 underwent debridement, antibiotics, and implant retention (DAIR); 1 had exchange arthroplasty; and 4 were managed non-operatively. Antimicrobial treatment also varied considerably. All patients achieved clinical cure. Lyme disease should be considered a potential cause of culture-negative PJI occurring in endemic regions. Because Borrelia-targeted PCR is not routinely included in standard PJI diagnostic workup, diagnosis may be delayed; therefore, clinicians should consider ordering this test when Lyme PJI is part of the differential.