Homebuilding takes a breather; wholesale prices up

WASHINGTON (Reuters) - U.S. builders broke ground on fewer homes last month but a jump in permits for future construction to a 4-1/2-year high indicated the housing market recovery remains on track.

Another report on Wednesday showed wholesale prices rose in January for the first time in four months. However, the gain was smaller than expected and left scope for the Federal Reserve to keep buying bonds to stimulate the economy.

Housing starts dropped 8.5 percent in January to an 890,000-unit annual rate, pulled down by a sharp drop in the volatile multi-family unit category, the Commerce Department said.

Starts for single-family homes hit their highest level since July 2008, and permits for future construction, which lead starts by at least a month, were at their highest level since June 2008.

The drop in starts followed an outsized gain in December and was confined to the Northeast and Midwest, suggesting winter weather likely contributed to the pullback.

"The fundamentals are there and the drivers are looking good," said Patrick Newport, an economist at IHS Global Insight in Lexington, Massachusetts. "We see more new construction this year. The only question is whether it will be in the multi-family or single-family segment."

Housing has shifted from being a headwind for the economy to being a pillar of support, although mortgage rates have crept higher in recent weeks, cooling loan demand.

Luxury homebuilder Toll Brothers on Wednesday reported disappointing quarterly results, hurt in part by lower selling prices, but other homebuilders have been able to take advantage of the recovering market.

A separate report from the Labor Department showed producer prices rose 0.2 percent last month as rebounding food costs offset declining gasoline prices. Wholesale prices had slipped 0.3 percent in December, and economists had expected them to rise 0.4 percent in January.

Food prices accounted for more than 75 percent of the rise in wholesale prices last month.

INFLATION PRESSURES MUTED

Away from the spike in food prices, the producer price report showed inflation pressures were generally muted.

In the 12 months through January, wholesale prices were up 1.4 percent and data on Thursday is expected to show consumer inflation below the U.S. central bank's goal of 2 percent.

"Inflationary pressures remain well contained," said Diane Swonk, chief economist at Mesirow Financial in Chicago. "The Federal Reserve would rather see inflation slightly higher in response to stronger economic conditions than benign because the recovery remains tepid."

In an effort to drive down borrowing costs and spur stronger growth, the Fed last year launched an open-ended bond buying program and said it would keep it up until it saw a substantial improvement in the outlook for the labor market.

But minutes of the U.S. central bank's January 29-30 meeting showed a number of policymakers believed the Fed might have to slow or stop asset purchases before seeing an acceleration in job growth because of concerns over the costs.

U.S. stocks fell on the minutes, with the Standard & Poor's 500 index posting its biggest one day percentage decline since mid-November.

The dollar rose against a basket of currencies. Prices for U.S. Treasury debt ended higher.

Wholesale prices excluding volatile food and energy costs edged up 0.2 percent last month after gaining 0.1 percent in December. In the 12 months through January, those so-called core prices rose 1.8 percent, the smallest gain since February 2011.

A surge in the cost of fresh and dried vegetables pushed up food prices in January. Gasoline prices surprisingly recorded another substantial decline last month, even though prices at the pump have been rising almost every week this year.

The core PPI was lifted by a jump in the cost of drugs, while passenger car and light truck prices fell.

(Additional reporting by Jason Lange; Editing by Andrea Ricci, Tim Ahmann and Leslie Adler)

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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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Apple’s Retina display for the next-gen iPad mini is reportedly already in development

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Jodi Arias Testifies: I Don't Remember Stabbing My Lover 27 Times

Update

By Howard Breuer

UPDATED
02/20/2013 at 05:45 PM EST

• Originally published 02/20/2013 at 05:00 PM EST

Jodi Arias

Charlie Leight/The Arizona Republic/AP

Nearly two months into her murder trial in a Phoenix courtroom, Jodi Arias told jurors Wednesday morning that she killed Travis Alexander in self-defense – but doesn't remember stabbing him nearly 30 times.

"I just remember dropping the knife and being very freaked out and screaming," Arias, 32, said after two weeks of explicit direct testimony about her sex life with Alexander, including their kinky sex shortly before his death. She says the knife was the same one Alexander had used that afternoon when he tied her up for sex.

Facing the death penalty if convicted, Arias says her memory of June 4, 2008, clears up when she put the knife in the dishwasher. Driving off barefoot, she brought with her the rope she said Alexander had used to tie her up and a gun that she pulled from the top of his walk-in closet before shooting him.

"I was very scared and very upset. ... I just wanted to die," Arias testified. "I thought, 'My life is probably done now.'"

She says she decided to bury those feelings and try to act normal as she drove north into Utah to visit another man with whom she already had plans to see.

She says she tossed the gun in the desert, dropped the rope in a Dumpster near St. George, Utah, washed the blood from her hands with a case of bottled Costco water she kept in her trunk and put on a spare pair of work shoes.

The man she met, Ryan Burns, earlier testified that Arias was frisky and affectionate when she visited on June 5. Arias testified that she kissed Burns and cuddled with him the day after killing Alexander because, "I felt safe right there and, I figured, I just wanted to seem normal, like I didn't just do what I just did."

Centerpiece of Defense

Arias's testimony was the long-anticipated centerpiece of her defense. Once that's done, prosecutors are expected to spend several days trying to pick apart her story.

Arias also talked about how she and Alexander, a charismatic Mormon motivational speaker, had an off-and-on relationship in which he sometimes become violent or sadistic.

She says she had arrived at his Mesa, Ariz. home at 5 a.m. and although they took photos and video of themselves having sex, Alexander repeatedly became enraged with her – first for giving him badly scratched CDs of photographs of their trips together, then for dropping his camera.

She says that as Alexander chased her through a walk-in closet "like a linebacker," she grabbed a gun that she knew he kept on a top shelf. She says that she held up the gun, expecting that Alexander would stop charging at her, but he didn't.

"The gun went off, I didn't even mean to shoot, I didn't know my hand was on the trigger," Arias testified. She says that, as they wrestled on the ground, she assumed that she'd shot a hole in the wall, not that she'd hit Alexander. After that, she says, "there's a lot of that day that I don't remember, there's a lot of gaps.

"I have no memory of stabbing him," Arias told jurors, who have heard graphic testimony that Alexander was shot in the head and repeatedly stabbed, and that his throat was slashed ear to ear.

Arias testified she remembers standing in his bathroom, dropping the knife on the hard floor, and thinking, "that I just couldn't believe what had just happened and I couldn't rewind the clock and take it back." She did not recall dragging him to the bathroom or placing him in the shower, she said.

Arias also testified that she still loves Alexander – "It's a different love but yes, I do."

Since the slaying, Arias has changed her story, first saying she had no connection to the crime, then saying two masked intruders killed Alexander and almost killed her. "I basically told everyone what I could remember of the day, and that the intruder story was all B.S.," Arias said Wednesday afternoon at the close of her testimony.

Prosecutors suggest Arias killed Alexander out of jealousy after he pushed her out of his life and started dating someone else, and that the gun was actually a pistol that she stole from her grandparents' home in Yreka, Calif., weeks earlier.

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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.

___

Stobbe reported from Atlanta.

___

Online:

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

CDC: http://www.cdc.gov

___

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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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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MTV Fake-Hacks Its Own Twitter Handle, Proving That MTV Is Still Terrible

On Tuesday afternoon, just as the week of the big-brand Twitter hack was getting as old as it was useful to the “victims,” the Twitter feeds of BET and MTV — both owned by the media conglomerate Viacom — were “hacked.” Except they weren’t, in fact, hacked. They were stunt-hacked in a pre-planned, inter-office joke that turned into a viral marketing ploy gone bad.

RELATED: 4 Reasons To Praise Twitter’s New URL Shortener

On Monday hackers took to Burger King’s Twitter feed in a fake McDonald’s takeover that gained the brand 30,000 followers and a whole lot of social-media brand recognition, almost by accident. By midday Tuesday, Jeep had been “taken over” by hackers posing as Cadillac, and thousands of followers came with the very similar “attack.” But the social-media teams at BET and MTV had already noticed the bump, and had some “fun” in store. Which, because this is Twitter and jokes last about a day, didn’t end up much fun for anyone involved — and because this is MTV, definitely ended up in making the network look even more behind the times than usual.

RELATED: Does Google Have a Double Agent at Twitter?

We spotted this message (since deleted) from BET’s “social media pugilist”:

RELATED: The New York Times’s Bill Keller Riles Up Twitter

And there was this evidence, from an MTV marketing director’s feed minutes before the reality-TV channel was hacked:

MTV Marketing Director @schoprah tweets about the #MTVhack 4 minutes before the first “hacked” @mtv post:twitpic.com/c563h6

— Ellie Hall (@ellievhall) February 19, 2013

And have at these musings that MTV’s social media manger, Tom Fischman, tweeted after Burger King was hacked yesterday:

Is there any real downside to the @burgerking hack? Mistake leaving the account suspended all day, would have seen a nice follower windfall.

— Thomas Fishman (@Tom_Fishman) February 18, 2013

@mcbc Nobody thinks BK tweeted that stuff, doesn’t really reflect on them at all. Just bought them a ton of publicity, sympathy if anything.

— Thomas Fishman (@Tom_Fishman) February 18, 2013

The stunt certainly earned MTV and BET a bunch of publicity — like this post that you’re reading! — but came with the price of Twitter’s scorn … and no real bump in followers to either feed, either up or down:

I knew MTV wasn’t hacked when their content continued to still be complete crap.

— Andrew Kaczynski (@BuzzFeedAndrew) February 19, 2013

I hope @twitter suspends @mtv and @bet just for being asshats

— Peter Ha (@ThePeterHa) February 19, 2013

It’s days like today that make me hate the Internet.

— Jared Keller (@jaredbkeller) February 19, 2013

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How Does Fergie's Maternity Style Stack Up to Kate, Jessica and Kim?

Stylewatch
Style News Now

02/19/2013 at 03:31 PM ET

Getty; GSI; Abaca; Xposure

When we heard that Fergie was expecting a baby Black Eyed Pea, we were on the edge of our seats waiting to see how the famously funky star‘s maternity style would play out. Luckily she didn’t keep us waiting long, stepping out with husband Josh Duhamel Tuesday in a shearling bomber jacket, yellow sweater dress and circular sunglasses.

“It’s clear to see how happy they are,” a source close to the couple tells PEOPLE. ”They are really excited.” And we are really excited to see how her outfits fit into the range of maternity style — from low-key to high-wattage — that we’ve been spotting from L.A. to London.

On the “mild” end of the spectrum is the Duchess of Cambridge (left), who has dressed her barely-there bump in conservative coats and this elegant Max Mara wrap dress.

A little wilder is Jessica Simpson, wearing a pink jacket with Jessica Simpson Maternity leggings, who sticks to the same styles she favors even when not pregnant (blazers, maxis and sky-high heels) but isn’t shy about putting her fuller curves on display with plunging V-necks.

And on the far end of the “mild to wild”-o-meter: Kim Kardashian, of course, who has put her bump on display in feathers, crop tops, mesh, sequins and sheer numbers — including this onesie pantsuit.

As it turns out, these stars’ maternity style isn’t so different from how they dressed pre-baby … which makes us even more excited to see how the rest of their pregnancy wardrobe will go. Tell us: Who’s the best-dressed mom-to-be?

–Alex Apatoff

PHOTOS: SEE MORE STAR MATERNITY STYLE HERE!

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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."

___

Online:

Journal: http://www.jamainternalmed.com

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