French general urges EU to equip "impoverished" Mali army

BAMAKO, Mali (Reuters) - The European Union should complement a mission to train Mali's army, routed by rebels last year, by providing equipment from uniforms to vehicles and communications technology, a French general said on Wednesday.

General Francois Lecointre, appointed to head the EU training mission to Mali (EUTM) that was formally launched this week, said in Bamako equipping the "very impoverished" and disorganized Malian army was as important as training it.

Europe, along with the United States, has backed the French-led military intervention in Mali which since January 11 has driven al Qaeda-allied Islamist insurgents out of the main northern towns into remote mountains near Algeria's border.

European governments have ruled out sending combat troops to join French and African soldiers pursuing the Islamist rebels.

But the EU is providing a 500-strong multinational training force that will give military instruction to Malian soldiers for an initial period of 15 months at an estimated cost of 12.3 million euros ($16.45 million).

While hailing what he called the EU's "courageous, novel, historic" decision to support Mali, Lecointre told a news conference the Malian army's lack of equipment was a problem.

"I know the Malian state is poor, but the Malian army is more than poor," the French general told a news conference, adding that it urgently needed everything from uniforms and weapons to vehicles and communications equipment.

Last year, when Tuareg separatist forces swelled by weapons and fighters from the Libyan conflict swept out of the northern deserts, a demoralized and poorly-led Malian army collapsed and fled before them, abandoning arms and vehicles.

Mali's military was further shaken by a March 22 coup by junior officers who toppled President Amadou Toumani Toure, sowing division among rival army factions. Islamist radicals allied to al Qaeda later hijacked the victorious Tuareg rebellion to occupy the northern half of the country.

In a fast-charging military campaign led by Paris, French and African troops have driven the jihadists out of principal northern towns like Gao and Timbuktu, and are fighting the rebels in the Adrar des Ifoghas mountains.

HUMAN RIGHTS INSTRUCTION

Flanked by Mali's armed forces chief, General Ibrahima Dembele, Lecointre said he was disappointed that a meeting of international donors last month pledged funds for an African military force, known as AFISMA, being deployed in Mali, but included "very few" contributions for the Malian army itself.

"The European Union needs to invest today in the equipping of the Malian army and not just in its training," the general said, adding he would make this point strongly in a report to EU member state representatives early next month.

Asked how much re-equipping the army would cost, he said it would be "much more" than the 12 million euros of EU financing for the training mission, but could not give a precise estimate.

Starting early in April, the EU mission will start instructing Malian soldiers with a plan to train four new battalions of 600-700 members each, formed from existing enlisted men and new recruits.

Lecointre said the EU training would include instruction in human rights. Demands for this increased after allegations by Malian civilians and international human rights groups that Malian soldiers were executing Tuaregs and Arabs accused of collaborating with Islamist rebels.

The European training contingent is drawn from a range of European countries, but the main contributors would be France, Germany, Italy, Spain and Britain, EUTM officers said.

Mali's army has received foreign training before - several battalions that fled before the rebels last year were trained by the U.S. military and the leader of the March 22 coup, Captain Amadou Sanogo, attended training courses in the United States.

Dembele said U.S. training failed to forge cohesion among Malian units and he hoped the EU training would achieve this.

The United States, which halted direct support for the Malian military after last year's coup, could eventually resume aid if planned national elections in July fully restore democracy to the West African country.

Washington is providing airlift, refuelling and intelligence support to the French-led military intervention in Mali. ($1 = 0.7479 euros)

(Reporting by Pascal Fletcher; Editing by Jason Webb)

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Scientists use 3-D printing to help grow an ear

WASHINGTON (AP) — Printing out body parts? Cornell University researchers showed it's possible by creating a replacement ear using a 3-D printer and injections of living cells.

The work reported Wednesday is a first step toward one day growing customized new ears for children born with malformed ones, or people who lose one to accident or disease.

It's part of the hot field of tissue regeneration, trying to regrow all kinds of body parts. Scientists hope using 3-D printing technology might offer a speedier method with more lifelike results.

If it pans out, "this enables us to rapidly customize implants for whoever needs them," said Cornell biomedical engineer Lawrence Bonassar, who co-authored the research published online in the journal PLoS One.

This first-step work crafted a human-shaped ear that grew with cartilage from a cow, easier to obtain than human cartilage, especially the uniquely flexible kind that makes up ears. Study co-author Dr. Jason Spector of Weill Cornell Medical Center is working on the next step — how to cultivate enough of a child's remaining ear cartilage in the lab to grow an entirely new ear that could be implanted in the right spot.

Wednesday's report is "a nice advancement," said Dr. Anthony Atala, director of the Institute for Regenerative Medicine at Wake Forest Baptist Medical Center, who wasn't involved in the new research.

Three-dimensional printers, which gradually layer materials to form shapes, are widely used in manufacturing. For medicine, Atala said the ear work is part of broader research that shows "the technology now is at the point where we can in fact print these 3-dimensional structures and they do become functional over time."

Today, people who need a new ear often turn to prosthetics that require a rod to fasten to the head. For children, doctors sometimes fashion a new ear from the stiffer cartilage surrounding ribs, but it's a big operation. Spector said the end result seldom looks completely natural. Hence the quest to use a patient's own cells to grow a replacement ear.

The Cornell team started with a 3-D camera that rapidly rotates around a child's head for a picture of the existing ear to match. It beams the ear's geometry into a computer, without the mess of a traditional mold or the radiation if CT scans were used to measure ear anatomy.

"Kids aren't afraid of it," said Bonassar, who used his then-5-year-old twin daughters' healthy ears as models.

From that image, the 3-D printer produced a soft mold of the ear. Bonassar injected it with a special collagen gel that's full of cow cells that produce cartilage — forming a scaffolding. Over the next few weeks, cartilage grew to replace the collagen. At three months, it appeared to be a flexible and workable outer ear, the study concluded.

Now Bonassar's team can do the process even faster by using the living cells in that collagen gel as the printer's "ink." The 3-D technology directly layers the gel into just the right ear shape for cartilage to cover, without having to make a mold first.

The next step is to use a patient's own cells in the 3-D printing process. Spector, a reconstructive surgeon, is focusing on children born without a fully developed external ear, a condition called microtia. They have some ear cartilage-producing cells in that tissue, just not enough. So he's experimenting with ways to boost those cells in the lab, "so we can grow enough of them from that patient to make an ear," he explained.

That hurdle aside, cartilage may be the tissue most amenable to growing with the help of 3-D printing technology, he said. That's because cartilage doesn't need blood vessels growing inside it to survive.

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Wall Street ends down sharply after Fed minutes

(Reuters) - And the Oscar for best pickup line in a movie goes to - Audrey Hepburn in the romantic thriller, "Charade." That's according to the results from women polled by the U.K.-based dating site Badoo.com and released on Wednesday before the Academy Awards on Sunday. "I don't bite you know ... unless it's called for," Hepburn told Cary Grant in the 1963 release, and, 50 years later, women still chose it first. Men, however, had different ideas. They favored this Bette Davis line from the 1932 movie, "The Cabin in the Cotton," - "I'd love to kiss you, but I just washed my hair. ...

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Syria "Scud-type" missile said to kill 20 in Aleppo

AMMAN (Reuters) - A Syrian missile killed at least 20 people in a rebel-held district of Aleppo on Tuesday, opposition activists said, as the army turns to longer-range weapons after losing bases in the country's second-largest city.

The use of what opposition activists said was a large missile of the same type as Russian-made Scuds against an Aleppo residential district came after rebels overran army bases over the past two months from which troops had fired artillery.

As the uprising against President Bashar al-Assad, now a civil war, nears its two-year mark, rebels also landed three mortar bombs in the rarely-used presidential palace compound in the capital Damascus, opposition activists said on Tuesday.

The United Nations estimates 70,000 people have been killed in the conflict between largely Sunni Muslim rebels and Assad's supporters among his minority Alawite sect. An international diplomatic deadlock has prevented intervention, as the war worsens sectarian tensions throughout the Middle East.

A Russian official said on Tuesday that Moscow, which is a long-time ally of Damascus, would not immediately back U.N. investigators' calls for some Syrian leaders to face the International Criminal Court for war crimes.

Moscow has blocked three U.N. Security Council resolutions that would have increased pressure on Assad.

Casualties are not only being caused directly by fighting, but also by disruption to infrastructure and Syria's economy.

An estimated 2,500 people in a rebel-held area of northeastern Deir al-Zor province have been infected with typhoid, which causes diarrhea and can be fatal, due to drinking contaminated water from the Euphrates River, the World Health Organization (WHO) said on Tuesday.

"There is not enough fuel or electricity to run the pumps so people drink water from the Euphrates which is contaminated, probably with sewage," the WHO representative in Syria, Elisabeth Hoff, told Reuters by telephone.

The WHO had no confirmed reports of deaths so far.

BURIED UNDER RUBBLE

In northern Aleppo, opposition activists said 25 people were missing under rubble of three buildings hit by a several-meter-long missile. They said remains of the weapon showed it to be a Scud-type missile of the type government forces increasingly use in Aleppo and in Deir a-Zor.

NATO said in December Assad's forces fired Scud-type missiles. It did not specify where they landed but said their deployment was an act of desperation.

Bodies were being gradually dug up, Mohammad Nour, an activist, said by phone from Aleppo.

"Some, including children, have died in hospitals," he said.

Video footage showed dozens of people scouring for victims and inspecting damage. A body was pulled from under collapsed concrete. At a nearby hospital, a baby said to have been dug out from wreckage was shown dying in the hands of doctors.

Reuters could not independently verify the reports.

Opposition activists also reported fighting near the town of Nabak on the Damascus-Homs highway, another route vital for supplying forces in the capital loyal to Assad, whose family has ruled Syria since the 1960s.

Rebels moved anti-aircraft guns into the eastern Damascus district of Jobar, adjacent to the city centre, as they seek to secure recent gains, an activist said.

"The rebels moved truck-mounted anti-aircraft guns to Jobar and are now firing at warplanes rocketing the district," said Damascus activist Moaz al-Shami.

Russian Deputy Foreign Minister Gennady Gatilov told a news conference a U.N. war crimes report, which accuses military leaders and rebels of terrorizing civilians, was "not the path we should follow ... at this stage it would be untimely and unconstructive."

Syria is not party to the Rome Statute that established the ICC and the only way the court can investigate the situation is if it receives a referral from the Security Council, where Moscow is a permanent member.

(Writing by Oliver Holmes; Editing by Jason Webb)

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Kelly Clarkson: 'I Refuse to Be Bullied' by Clive Davis

By Patrick Gomez

02/19/2013 at 06:00 PM EST

Kelly Clarkson; Clive Davis

Kevin Mazur/Wireimage; Dan Hallman/Invision/AP

Clive Davis may have made headlines by revealing his bisexuality in his new memoir, but Kelly Clarkson is more concerned about what he's written in regards to her career.

"I refuse to be bullied and I just have to clear up his memory lapses and misinformation," the recent Grammy winner wrote Tuesday on WhoSay. "It feels like a violation."

In his newly released memoir The Soundtrack of My Life, Davis recalls a meeting with Clarkson that was "a very tough conversation, and it didn't get any easier when Kelly burst in to hysterical sobbing," while discussing the inclusion of "Since U Been Gone" on her second album, Breakaway.

"Not true at all," Clarkson says. "His stories and songs are mixed up. I couldn't be more proud of that song. I resent him dampening that song in any way."

Clarkson goes on to state that she did cry in the meeting but not about "Since U Been Gone."

"I cried after I played him a song I had written about my life called 'Because of You,' " she says. "He hated it and told me verbatim that I was a 's–––ty writer who should be grateful for the gifts that he bestows upon me.' "

Davis recalls a completely different version of the "Because of You" conflict in his book, released Tuesday.

"In subsequent interviews Kelly said that she had to fight to get "Because of You" on the album, but that simply wasn't the case," Clive writes. "I have no idea where she heard that."

Despite the difference in memories, the engaged Clarkson remained positive in her blog.

"I love my job. I love my music. I love my fans," she says. "Growing up is awesome because you learn you don't have to cower to anyone – even Clive Davis."

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Drug overdose deaths up for 11th consecutive year

CHICAGO (AP) — Drug overdose deaths rose for the 11th straight year, federal data show, and most of them were accidents involving addictive painkillers despite growing attention to risks from these medicines.

"The big picture is that this is a big problem that has gotten much worse quickly," said Dr. Thomas Frieden, head of the Centers for Disease Control and Prevention, which gathered and analyzed the data.

In 2010, the CDC reported, there were 38,329 drug overdose deaths nationwide. Medicines, mostly prescription drugs, were involved in nearly 60 percent of overdose deaths that year, overshadowing deaths from illicit narcotics.

The report appears in Tuesday's Journal of the American Medical Association.

It details which drugs were at play in most of the fatalities. As in previous recent years, opioid drugs — which include OxyContin and Vicodin — were the biggest problem, contributing to 3 out of 4 medication overdose deaths.

Frieden said many doctors and patients don't realize how addictive these drugs can be, and that they're too often prescribed for pain that can be managed with less risky drugs.

They're useful for cancer, "but if you've got terrible back pain or terrible migraines," using these addictive drugs can be dangerous, he said.

Medication-related deaths accounted for 22,134 of the drug overdose deaths in 2010.

Anti-anxiety drugs including Valium were among common causes of medication-related deaths, involved in almost 30 percent of them. Among the medication-related deaths, 17 percent were suicides.

The report's data came from death certificates, which aren't always clear on whether a death was a suicide or a tragic attempt at getting high. But it does seem like most serious painkiller overdoses were accidental, said Dr. Rich Zane, chair of emergency medicine at the University of Colorado School of Medicine.

The study's findings are no surprise, he added. "The results are consistent with what we experience" in ERs, he said, adding that the statistics no doubt have gotten worse since 2010.

Some experts believe these deaths will level off. "Right now, there's a general belief that because these are pharmaceutical drugs, they're safer than street drugs like heroin," said Don Des Jarlais, director of the chemical dependency institute at New York City's Beth Israel Medical Center.

"But at some point, people using these drugs are going to become more aware of the dangers," he said.

Frieden said the data show a need for more prescription drug monitoring programs at the state level, and more laws shutting down "pill mills" — doctor offices and pharmacies that over-prescribe addictive medicines.

Last month, a federal panel of drug safety specialists recommended that Vicodin and dozens of other medicines be subjected to the same restrictions as other narcotic drugs like oxycodone and morphine. Meanwhile, more and more hospitals have been establishing tougher restrictions on painkiller prescriptions and refills.

One example: The University of Colorado Hospital in Aurora is considering a rule that would ban emergency doctors from prescribing more medicine for patients who say they lost their pain meds, Zane said.

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Stobbe reported from Atlanta.

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Online:

JAMA: http://www.jama.ama-assn.org

CDC: http://www.cdc.gov

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com

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M&A deals lift Wall Street shares nearer a record high

NEW YORK (Reuters) - U.S. stocks rose on Tuesday as this year's ongoing surge in merger activity suggested investors were still finding value in the market even as indexes closed in on all-time highs.

Office Depot Inc surged 9.4 percent to $5.02 after a person familiar with the matter said the No. 2 U.S. office supply retailer was in advanced talks to merge with smaller rival OfficeMax Inc , which jumped more than 20 percent.

News of the potential move came just days after Berkshire Hathaway and a partner agreed to acquire H.J. Heinz Co for $23 billion, and following a revised $20 billion takeover of Mexican brewer Grupo Modelo by Anheuser-Busch InBev .

Deal activity has helped equities resist a pullback as investors use dips in stocks as buying opportunities. The S&P is up about 7 percent so far in 2013 and has climbed for the past seven weeks in its longest weekly winning streak since January 2011, though most of the weekly gains have been slim.

The Dow industrials closed 0.9 percent away from their record high while S&P 500 was 2.2 percent off its peak.

"Deals are good for the market," said Frank Lesh, a futures analyst and broker at FuturePath Trading LLC in Chicago. "The fact that they're being done is a positive."

More than $158 billion in deals has been announced so far in 2013, more than double the activity in the same period last year and accounting for 57 percent of global deal volumes, according to Thomson Reuters Deals Intelligence.

The Dow Jones industrial average <.dji> gained 53.91 points, or 0.39 percent, to 14,035.67. The Standard & Poor's 500 Index <.spx> gained 11.15 points, or 0.73 percent, to 1,530.94. The Nasdaq Composite Index <.ixic> gained 21.56 points, or 0.68 percent, to 3,213.59.

Other stocks in the office supplies sector also rose. Larger rival Staples Inc shot up 13.1 percent to $14.65 as the best performer on the S&P 500.

"Equity investors have to be encouraged by M&A since, if the number crunchers are offering large premiums, that shows how much value is still in the market," said Mike Gibbs, co-head of the equity advisory group at Raymond James in Memphis, Tennessee.

On the downside, health insurance stocks tumbled, led by a 6.4 percent drop in Humana Inc to $73.01. The company said the government's proposed 2014 payment rates for Medicare Advantage participants were lower than expected and would hurt its profit outlook.

UnitedHealth Group lost 1.2 percent to $56.66. The Morgan Stanley healthcare payor index <.hmo> dropped 1.2 percent.

Wall Street's strong start to the year was fueled by better-than-expected corporate earnings, as well as a compromise in Washington that temporarily averted automatic spending cuts and tax hikes that are predicted to damage the economy.

The compromise on across-the-board spending cuts postponed the matter until March 1, at which point the cuts take effect. Ahead of the debate over the cuts, known as sequestration, further gains for stocks may be difficult to come by.

Some investors say the debate could be the catalyst for a long anticipated sell-off after the market's recent strong run.

Carter Worth, a technical analyst at Oppenheimer, pointed to the "especially complacent action of the past six weeks," noting that, as of Friday, stocks have gone 33 sessions without a dip of more than 1.5 percent.

"We would be selling aggressively into the market's current strength," he said in a research note.

Economic data showed the NAHB/Wells Fargo Housing Market index unexpectedly edged down to 46 in February from 47 in the prior month as builders faced higher material costs.

According to the Thomson Reuters data through Monday morning, of the 391 companies in the S&P 500 that have reported results, 70.1 percent have exceeded analysts' expectations, compared with a 62 percent average since 1994 and 65 percent over the past four quarters.

Fourth-quarter earnings for S&P 500 companies have risen 5.6 percent, according to the data, above a 1.9 percent forecast at the start of the earnings season.

Express Scripts rose 2.5 percent to $56.98 after the pharmacy benefits manager posted fourth-quarter earnings.

About two stocks rose for everyone that fell on the New York Stock Exchange and Nasdaq. About 6.48 billion shares changed hands on the New York Stock Exchange, the Nasdaq and NYSE MKT, in line with the daily average so far this year.

(Additional reporting by Chuck Mikolajczak Ryan Vlastelica and Rodrigo Campos; Editing by Chizu Nomiyama, Kenneth Barry and Nick Zieminski)

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Time to refer Syrian war crimes to ICC: U.N. inquiry

GENEVA (Reuters) - United Nations investigators said on Monday that Syrian leaders they had identified as suspected war criminals should face the International Criminal Court (ICC).

The investigators urged the U.N. Security Council to "act urgently to ensure accountability" for violations, including murder and torture, committed by both sides in an uprising and civil war that has killed about 70,000 people since March 2011.

"Now really it's time ... We have a permanent court, the International Criminal Court, who would be ready to take this case," Carla del Ponte, a former ICC chief prosecutor who joined the U.N. team in September, told a news briefing in Geneva.

But because Syria is not party to the Rome Statute that established the ICC, the only way the court can investigate the situation is if it receives a referral from the Security Council. Russia, Assad's long-standing ally and a permanent veto-wielding member of the council, has opposed such a move.

"We cannot decide. But we pressure the international community to decide because it's time to act," del Ponte said.

Brazilian expert Paulo Pinheiro, who leads the U.N. inquiry set up in 2011, said: "We are in very close dialogue with all the five permanent members and with all the members of the Security Council, but we don't have the key that will open the path to cooperation inside the Security Council."

His team of some two dozen experts is tracing the chain of command in Syria to establish criminal responsibility and build a case for eventual prosecution.

"Of course we were able to identify high-level perpetrators," del Ponte said, adding that these were people "in command responsibility...deciding, organizing, planning and aiding and abetting the commission of crimes".

She said it was urgent for the Hague-based war crimes tribunal to take up cases of "very high officials", but did not identify them, in line with the inquiry's practice.

"We have crimes committed against children, rape and sexual violence. We have grave concerns. That is also one reason why an international body of justice must act because it is terrible."

Del Ponte, who tried former Yugoslav President Slobodan Milosevic at the International Criminal Tribunal for the Former Yugoslavia on war crimes charges, said the ICC prosecutor would need to deepen the investigation on Syria before an indictment could be prepared.

Karen Koning AbuZayd, an American member of the U.N. team, told Reuters it had information pointing to "people who have given instructions and are responsible for government policy, people who are in the leadership of the military, for example".

The inquiry's third roster of suspects, building on lists drawn up in the past year, remains secret. It will be entrusted to U.N. High Commissioner for Human Rights Navi Pillay upon expiry of its mandate at the end of March, the report said.

Pillay, a former ICC judge, said on Saturday Assad should be investigated for war crimes, and called for outside action on Syria, including possible military intervention.

Pinheiro said the investigators would not speak publicly about "numbers, names or levels" of suspects.

SEVEN MASSACRES IDENTIFIED

The investigators' latest report, covering the six months to mid-January, was based on 445 interviews conducted abroad with victims and witnesses, as they have not been allowed into Syria.

"We identified seven massacres during the period, five on the government side, two on the armed opponents' side. We need to enter the sites to be able to confirm elements of proof that we have," del Ponte said.

The U.N. report said the ICC was the appropriate institution for the fight against impunity in Syria. "As an established, broadly supported structure, it could immediately initiate investigations against authors of serious crimes in Syria."

Government forces have carried out shelling and air strikes across Syria including Aleppo, Damascus, Deraa, Homs and Idlib, the 131-page report said, citing corroborating satellite images.

"Government forces and affiliated militias have committed extra-judicial executions, breaching international human rights law. This conduct also constitutes the war crime of murder. Where murder was committed as part of a widespread or systematic attack against a civilian population, with knowledge of that attack, it is a crime against humanity," the report said.

Those forces have targeted bakery queues and funeral processions to spread "terror among the civilian population".

Rebels fighting to topple Assad have also committed war crimes including murder, torture, hostage-taking and using children under age 15 in hostilities, the U.N. report said.

"They continue to endanger the civilian population by positioning military objectives inside civilian areas" and rebel snipers had caused "considerable civilian casualties", it said.

George Sabra, a vice president of the opposition Syrian National Coalition, asked about the U.N. report, told Reuters at a conference in Stockholm: "We condemn all kind of crimes, regardless who did it.

"We can't ignore that some mistakes have been made and maybe still happen right now. But nobody also can ignore that the most criminal file is that of the regime."

(This story has been corrected to fix name of Milosevic tribunal in 11th paragraph)

(Reporting by Stephanie Nebehay; additional reporting by Anna Ringstrom in Stockholm; Editing by Mark Heinrich)

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Mindy McCready: Under Police Scrutiny at Time of Suicide?

By Steve Helling and Mike Fleeman

02/18/2013 at 06:00 PM EST

Mindy McCready and David Wilson

Courtesy Mindy McCready

When Mindy McCready talked to police in recent weeks, her account of how her boyfriend came to be found with a fatal gunshot wound to the head concerned police, a law enforcement source tells PEOPLE.

"At first, she said she hadn't heard the gunshot because the TV was too loud. Then she said she had heard the gunshot," the source says. "So obviously there were a lot of questions, and the Sheriff was asking for clarification."

But before investigators could re-interview her, the long-troubled country singer also would die under eerily similar circumstances, her body discovered at the same Heber Springs, Ark., house just feet away from where David Wilson died.

McCready's death was blamed on what "appears to be a single self-inflicted gunshot wound," the Cleburne County Sheriff's Office said in a statement.

This differed from how the sheriff characterized Wilson's case. His cause and manner of death still have not been established by the coroner. It was McCready's publicist, and not a law enforcement official, who announced that Wilson had died of a self-inflicted gunshot wound.

After Wilson's death, McCready, 37, spoke to investigators three times, but they didn't feel as if they were through with her.

"At no point did [police] tell her she was a suspect, and she wasn't officially one," says the source. "But she knew that some of her answers didn't stand up to questioning. She was very cooperative, but she just wasn't making a lot of sense."

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Hip implants a bit more likely to fail in women

CHICAGO (AP) — Hip replacements are slightly more likely to fail in women than in men, according to one of the largest studies of its kind in U.S. patients. The risk of the implants failing is low, but women were 29 percent more likely than men to need a repeat surgery within the first three years.

The message for women considering hip replacement surgery remains unclear. It's not known which models of hip implants perform best in women, even though women make up the majority of the more than 400,000 Americans who have full or partial hip replacements each year to ease the pain and loss of mobility caused by arthritis or injuries.

"This is the first step in what has to be a much longer-term research strategy to figure out why women have worse experiences," said Diana Zuckerman, president of the nonprofit National Research Center for Women & Families. "Research in this area could save billions of dollars" and prevent patients from experiencing the pain and inconvenience of surgeries to fix hip implants that go wrong.

Researchers looked at more than 35,000 surgeries at 46 hospitals in the Kaiser Permanente health system. The research, published Monday in JAMA Internal Medicine, was funded by the U.S. Food and Drug Administration.

After an average of three years, 2.3 percent of the women and 1.9 percent of the men had undergone revision surgery to fix a problem with the original hip replacement. Problems included instability, infection, broken bones and loosening.

"There is an increased risk of failure in women compared to men," said lead author Maria Inacio, an epidemiologist at Southern California Permanente Medical Group in San Diego. "This is still a very small number of failures."

Women tend to have smaller joints and bones than men, and so they tend to need smaller artificial hips. Devices with smaller femoral heads — the ball-shaped part of the ball-and-socket joint in an artificial hip — are more likely to dislocate and require a surgical repair.

That explained some, but not all, of the difference between women and men in the study. It's not clear what else may have contributed to the gap. Co-author Dr. Monti Khatod, an orthopedic surgeon in Los Angeles, speculated that one factor may be a greater loss of bone density in women.

The failure of metal-on-metal hips was almost twice as high for women than in men. The once-popular models were promoted by manufacturers as being more durable than standard plastic or ceramic joints, but several high-profile recalls have led to a decrease in their use in recent years.

"Don't be fooled by hype about a new hip product," said Zuckerman, who wrote an accompanying commentary in the medical journal. "I would not choose the latest, greatest hip implant if I were a woman patient. ... At least if it's been for sale for a few years, there's more evidence for how well it's working."

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Online:

Journal: http://www.jamainternalmed.com

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