ORTHOPEDIC device infections in children present a unique clinical challenge, with distinct differences from adult cases in both patient characteristics and treatment requirements, according to a newly published review. These infections are most commonly linked to spinal hardware and limb-salvage prostheses, particularly in pediatric patients with neuromuscular conditions or bone tumors.
Children receiving orthopedic implants often have underlying conditions that contribute to both the complexity and the risk of infection. The review emphasizes that the pathogenesis and progression of these infections differ markedly from those in adults. For instance, the immune responses, microbial patterns, and healing capacities in children create a different risk profile, which requires highly individualized treatment plans.
Diagnosis can be particularly challenging due to the diverse presentations and the frequent presence of non-specific symptoms. For spinal hardware infections, common in children with neuromuscular disorders, symptoms may overlap with baseline functional limitations, delaying recognition. Meanwhile, limb-salvage procedures performed for bone tumors often involve extensive implants and are further complicated by immunosuppression from chemotherapy, making infections harder to detect and treat.
Management strategies must be tailored to the specific clinical scenario, taking into account the patient’s age, comorbidities, device type, and microbial etiology. Surgical revision, prolonged antimicrobial therapy, and coordination with oncology or neurology teams are often necessary. The review underscores the importance of early identification and a multidisciplinary approach to improve long-term outcomes.
As the use of orthopedic implants increases in pediatric populations, especially in complex cases, understanding the unique aspects of infection risk and treatment in these patients is essential for optimizing care. Pediatric-specific research and guidelines remain limited, making this review a timely resource for clinicians navigating these demanding clinical scenarios.
Reference:
Arnold SR, Wolf J. Orthopedic Device Infections in Children. Infect Dis Clin North Am. 2025 Jun 26:S0891-5520(25)00053-4. [Online ahead of print]
