Copy to clipboard 
Pediatrics is often underrepresented in orthopedics. While at AAOS earlier this month, we took the opportunity to speak with John F. Lovejoy III, M.D., Chair of Orthopedic and Sports Medicine at Nemours Children’s Hospital Florida. Along with his leadership position and busy practice, Dr. Lovejoy is actively engaged in research, including spinal deformity, sports medicine, and trauma.
Dr. Lovejoy is a third-generation orthopedic surgeon who brings decades of perspective to the field. During our conversation, he shared why it’s an exciting time for pediatric orthopedics, where gaps in treatment options remain, and what the future might hold for the specialty.
What clinical trends and new developments are you seeing in pediatrics today?
Dr. Lovejoy: There have been many exciting developments in pediatric orthopedics over the last decade.
I’ve noticed a strong emphasis on subspecializing in pediatrics. Physicians used to do a little bit of everything. More often than not, they’re now focusing on spine deformity, limb deformity and correction, and sports medicine. We’re now seeing trainees complete double fellowships. They’ll do a peds ortho fellowship and then a fellowship in another specialty. That has fostered a more innovative mindset and enabled us to focus on the transition from childhood to adulthood.
My practice is primarily spine deformity, and we see incredible technologies being applied there, whether it’s navigation, robotics or implant systems. Technology has revolutionized what we can do to improve kids’ lives. That innovation is what makes me excited about improving outcomes.
Looking to the future, I’m most excited about regenerative technologies. There’s a lot of work being done on absorbable implants. Some technologies could help us address complex issues we’ve never had good solutions for, like regrowing an anterior cruciate ligament instead of reconstructing it, or regrowing cartilage instead of performing secondary procedures to replace damaged cartilage. These would allow kids to return to activity after a sports injury or trauma incident.
Are there specific areas in spine you’d like to see addressed? Where do the gaps live?
Dr. Lovejoy: Artificial intelligence is going to play a more prominent role in all areas, but I think there’s a big opportunity in spine.
When we do a spine case, our minds process a lot of data to keep track of what we’re doing and how we’re doing it. Our processes are heavily influenced by our training and personal opinions instead of objective data. AI will help us review large volumes of data more effectively and understand how outcomes are occurring, and whether the outcomes we think we’re having are really the ones we have.
A benefit of AI that has been underplayed is its ability to identify gaps in our knowledge and work. What’s missing? What do we need to do to fix it? How do we focus research programs to fill those critical gaps?
AI will also play a role in advanced technologies such as robotics and navigation. AI’s processing time is so fast, and the ability to analyze images, convert them to digital format, and provide guidance are things we’re going to see more and more of. We’re already starting to see this with technologies that help minimize imaging needs and radiation exposure. But those are the proverbial low-hanging fruit compared to the complex scenarios AI will help with in the future.
You mentioned research. What specific research being done now excites you?
Dr. Lovejoy: Our institution is researching bioabsorbable implants. The ability to put in an implant that would be stable enough to secure a patient’s bone and then go away after a number of years would be amazing. We’re learning more about the physis and how it reacts to traumatic injuries. There’s also exciting work being done on Legg-Calve-Perthes disease.
Probably the single biggest impact, though, is new genetic therapies that are changing the course of disease processes, like spinal muscular atrophy (SMA), that we never thought would change. Genetic treatments are actually changing the natural history of this disease process, and these kids who never had muscle function are now developing it at different levels. When I was training, we never considered treating the hip pathologies of SMA patients. Now we need to ask ourselves whether we should start aggressive treatment on their hips. This may open a whole area of treatment that we hadn’t considered before.
Do you foresee more orthopedic surgeons specializing in pediatrics?
Dr. Lovejoy: The market largely drives the volume of surgeons going into any specialty. Over the last couple of years, we’ve seen an uptick in the number of people applying for fellowships. While that’s exciting, I don’t know whether the data would show a correlation with a larger percentage of surgeons retiring.
Pediatric orthopedics has been one of the least reimbursed fields and is traditionally associated with academia, which has made it less appealing to many surgeons. Also, our patient population is declining. The number of kids being born will affect the number of physicians entering peds ortho, as will new developments in the field.
There could be medical developments made in the next decade that may literally put us out of business in some areas and may open up new ones.
What else would you share with industry members?
Dr. Lovejoy: Industry is critical to our success, and that’s one area where peds has lagged compared to our adult colleagues. We have to maintain an emphasis on helping kids and on bringing innovation to market, just as we do in the adult world. That’s driven in part by market forces.
There is crossover between peds and adults, and a few innovative companies understand that perspective. Still, I would like to see industry be more engaged in helping us develop new products, implants and treatment plans for kids.
Of course, we have to make sure that industry can still achieve its financial outcomes. We need the government to fund programs that help support kids. A very large percentage of America’s children are on Medicaid programs. We need to make sure that programs are appropriately funded, so that it makes it worthwhile for companies that do investigative work.
Most of the genetic research is being done in the private sector. The Muscular Dystrophy Association was the primary driver of the development of genetic treatments for SMA. When those treatments came out, they were incredibly expensive. If you come out with a drug that cures a problem, but it costs a million dollars, it creates a tough situation for families and children.
There is a role for federal and state governments to ensure we’re providing adequate coverage and support for kids. Physicians and industry also need to be advocates. Kids can’t speak up for themselves, so we need to speak for them.
Pediatrics is often underrepresented in orthopedics. While at AAOS earlier this month, we took the opportunity to speak with John F. Lovejoy III, M.D., Chair of Orthopedic and Sports Medicine at Nemours Children’s Hospital Florida. Along with his leadership position and busy practice, Dr. Lovejoy is actively engaged in research, including spinal...
Pediatrics is often underrepresented in orthopedics. While at AAOS earlier this month, we took the opportunity to speak with John F. Lovejoy III, M.D., Chair of Orthopedic and Sports Medicine at Nemours Children’s Hospital Florida. Along with his leadership position and busy practice, Dr. Lovejoy is actively engaged in research, including spinal deformity, sports medicine, and trauma.
Dr. Lovejoy is a third-generation orthopedic surgeon who brings decades of perspective to the field. During our conversation, he shared why it’s an exciting time for pediatric orthopedics, where gaps in treatment options remain, and what the future might hold for the specialty.
What clinical trends and new developments are you seeing in pediatrics today?
Dr. Lovejoy: There have been many exciting developments in pediatric orthopedics over the last decade.
I’ve noticed a strong emphasis on subspecializing in pediatrics. Physicians used to do a little bit of everything. More often than not, they’re now focusing on spine deformity, limb deformity and correction, and sports medicine. We’re now seeing trainees complete double fellowships. They’ll do a peds ortho fellowship and then a fellowship in another specialty. That has fostered a more innovative mindset and enabled us to focus on the transition from childhood to adulthood.
My practice is primarily spine deformity, and we see incredible technologies being applied there, whether it’s navigation, robotics or implant systems. Technology has revolutionized what we can do to improve kids’ lives. That innovation is what makes me excited about improving outcomes.
Looking to the future, I’m most excited about regenerative technologies. There’s a lot of work being done on absorbable implants. Some technologies could help us address complex issues we’ve never had good solutions for, like regrowing an anterior cruciate ligament instead of reconstructing it, or regrowing cartilage instead of performing secondary procedures to replace damaged cartilage. These would allow kids to return to activity after a sports injury or trauma incident.
Are there specific areas in spine you’d like to see addressed? Where do the gaps live?
Dr. Lovejoy: Artificial intelligence is going to play a more prominent role in all areas, but I think there’s a big opportunity in spine.
When we do a spine case, our minds process a lot of data to keep track of what we’re doing and how we’re doing it. Our processes are heavily influenced by our training and personal opinions instead of objective data. AI will help us review large volumes of data more effectively and understand how outcomes are occurring, and whether the outcomes we think we’re having are really the ones we have.
A benefit of AI that has been underplayed is its ability to identify gaps in our knowledge and work. What’s missing? What do we need to do to fix it? How do we focus research programs to fill those critical gaps?
AI will also play a role in advanced technologies such as robotics and navigation. AI’s processing time is so fast, and the ability to analyze images, convert them to digital format, and provide guidance are things we’re going to see more and more of. We’re already starting to see this with technologies that help minimize imaging needs and radiation exposure. But those are the proverbial low-hanging fruit compared to the complex scenarios AI will help with in the future.
You mentioned research. What specific research being done now excites you?
Dr. Lovejoy: Our institution is researching bioabsorbable implants. The ability to put in an implant that would be stable enough to secure a patient’s bone and then go away after a number of years would be amazing. We’re learning more about the physis and how it reacts to traumatic injuries. There’s also exciting work being done on Legg-Calve-Perthes disease.
Probably the single biggest impact, though, is new genetic therapies that are changing the course of disease processes, like spinal muscular atrophy (SMA), that we never thought would change. Genetic treatments are actually changing the natural history of this disease process, and these kids who never had muscle function are now developing it at different levels. When I was training, we never considered treating the hip pathologies of SMA patients. Now we need to ask ourselves whether we should start aggressive treatment on their hips. This may open a whole area of treatment that we hadn’t considered before.
Do you foresee more orthopedic surgeons specializing in pediatrics?
Dr. Lovejoy: The market largely drives the volume of surgeons going into any specialty. Over the last couple of years, we’ve seen an uptick in the number of people applying for fellowships. While that’s exciting, I don’t know whether the data would show a correlation with a larger percentage of surgeons retiring.
Pediatric orthopedics has been one of the least reimbursed fields and is traditionally associated with academia, which has made it less appealing to many surgeons. Also, our patient population is declining. The number of kids being born will affect the number of physicians entering peds ortho, as will new developments in the field.
There could be medical developments made in the next decade that may literally put us out of business in some areas and may open up new ones.
What else would you share with industry members?
Dr. Lovejoy: Industry is critical to our success, and that’s one area where peds has lagged compared to our adult colleagues. We have to maintain an emphasis on helping kids and on bringing innovation to market, just as we do in the adult world. That’s driven in part by market forces.
There is crossover between peds and adults, and a few innovative companies understand that perspective. Still, I would like to see industry be more engaged in helping us develop new products, implants and treatment plans for kids.
Of course, we have to make sure that industry can still achieve its financial outcomes. We need the government to fund programs that help support kids. A very large percentage of America’s children are on Medicaid programs. We need to make sure that programs are appropriately funded, so that it makes it worthwhile for companies that do investigative work.
Most of the genetic research is being done in the private sector. The Muscular Dystrophy Association was the primary driver of the development of genetic treatments for SMA. When those treatments came out, they were incredibly expensive. If you come out with a drug that cures a problem, but it costs a million dollars, it creates a tough situation for families and children.
There is a role for federal and state governments to ensure we’re providing adequate coverage and support for kids. Physicians and industry also need to be advocates. Kids can’t speak up for themselves, so we need to speak for them.
You’ve reached your limit.
We’re glad you’re finding value in our content — and we’d love for you to keep going.
Subscribe now for unlimited access to orthopedic business intelligence.
CL
Carolyn LaWell is ORTHOWORLD's Chief Content Officer. She joined ORTHOWORLD in 2012 to oversee its editorial and industry education. She previously served in editor roles at B2B magazines and newspapers.
