Arias Leaves Stand After Describing Killing, Her Lies

Jodi Arias stepped down from the witness stand today after mounting an emotional effort to save herself from death row, insisting to the Arizona jury that an explosive fight with ex-boyfriend Travis Alexander led to his death, and that her lies about killing him masked deep regret and plans to commit suicide.

Arias, 32, will now face what is expected to be a withering cross-examination beginning Thursday from prosecutor Juan Martinez, who has been aggressive to many witnesses throughout the trial and who is expected to go after Arias' claim that she was forced to kill Alexander or be killed herself.

She is charged with murder for her ex-boyfriend's death and could face the death penalty if convicted.

Catching Up on the Trial? Check Out ABC News' Jodi Arias Trial Coverage

The day's dramatic testimony started with Arias describing the beginning of the fight on June 4, 2008 when she and Alexander were taking nude photos in his shower and she claims she accidentally dropped his new camera, causing Alexander to lose his temper. Enraged, he picked her up and body slammed her onto the tile floor, screaming at her, she told the jury.

Arias said she ran to his closet to get away from him, but could hear Alexander's footsteps coming after her down the hall. She grabbed a gun from his shelf and tried to keep running, but Alexander came after her, she said.

"I pointed it at him with both of my hands. I thought that would stop him, but he just kept running. He got like a linebacker. He got low and grabbed my waist, and as he was lunging at me the gun went off. I didn't mean to shoot. I didn't even think I was holding the trigger," she said.

"But he lunged at me and we fell really hard toward the tile wall, so at this point I didn't even know if he had been shot. I didn't see anything different. We were struggling, wrestling, he's a wrestler.

"So he's grabbing at my clothes and I got up, and he's screaming angry, and after I broke away from him. He said 'f***ing kill you bitch,'" she testified.

Asked by her lawyer whether she was convinced Alexander intended to kill her, Arias answered, "For sure. He'd almost killed me once before and now he's saying he was going to." Arias had earlier testified that Alexander had once choked her.

Timeline of the Jodi Arias Trial

Jodi Arias Describes Violent Sex Before Shooting Watch Video

Jodi Arias Testifies Ex Assaulted Her, Broke Her Fingers Watch Video

Jodi Arias Gives Explicit Details About Doomed Relationship Watch Video

But Arias' story of the death struggle ended there as she told the court that she has no memory of stabbing or slashing Alexander whose body was later found with 27 stab wounds, a slit throat and two bullets in his head. She said she only remembered standing in the bathroom, dropping the knife on the tile floor, realizing the "horror" of what had happened, and screaming.

"I have no memory of stabbing him," she said. "There's a huge gap. I don't know if I blacked out or what, but there's a huge gap. The most clear memory I have after that point is driving in the desert."

Arias said that she decided in the desert not to admit to killing Alexander, a decision that would last for two years as Arias lied to friends, family, investigators and reporters about what really happened in Alexander's bathroom.

During that time she initially claimed she got lost that night while driving to a friend's house and never went to Alexander's home in Mesa,Ariz. She later changed her story and said two masked people, a man and a woman, burst into the home and killed Alexander and threatened to kill her family if she told anyone what happened.

She eventually confessed to killing her ex-boyfriend, but insisted it was self defense.

"The main reason (for lying) is because I was very ashamed of what happened. It's not something I ever imagined doing. It's not the kind of person I was. It was just shameful," she said. "I was also very scared of what might happen. I didn't want my family to know that I had done that, and I just couldn't bring myself to say that I did that."

"From day one there was a part of me that always wanted to (tell the truth) but didn't dare do that. I would rather have gone to my grave than admit I had done something like that," she said.

Arias said that she continued to lie because she figured she would never get caught; she was planning to kill herself before trial.

"I was concerned with how it would affect my family. I wanted to die. I was going to definitely kill myself," she said. "That was my plan. You can purchase different things in jail and I bought a bunch of Advil... and took it all in the next few days so it was in my system. They have razors for shaving, so I got one and took it apart one night with intentions to slit my wrists."

Arias said she balked at slitting her wrists after accidentally cutting herself, but that she still planned to commit suicide sometime in the future. When she told news reporters that "no jury would convict her," she claims she said it believing that she would be dead before they'd have a chance to put her on trial, Arias testified.

Arias said support from the public and her family eventually led her to change her mind.

"My family remained very supportive, and told me 'it doesn't matter what happens, we love you anyway.' I realized even if I told the truth they would still be there and wouldn't walk away," she testified.

"By the time spring, 2010, rolled around, I confessed. I basically told everyone what I could remember of the day and that the intruder story was all BS pretty much."

She said that her testimony today, a third version of events, was the truth.

Arias was arrested a month after Alexander's death, and prosecutors have argued that her behavior during those weeks showed a lack of remorse for the killing and an attempt to get away with murder.

Arias said today that after she killed Alexander and drove away from his Mesa, Ariz., home in a panic, it dawned on her that police would soon be looking for Alexander's killer, and she decided that she would pretend the bloody confrontation had never happened.

"I knew that it was really bad, that my life was probably done now. I wished it was just a nightmare I could wake up from, but I knew I had messed up pretty badly and the inevitable was going to be something I could not really run from," she testified.

"I didn't want anyone to know that that had happened or that I did it, so I started taking steps in the aftermath to cover it up. I did a whole bunch of things to try to make it seem like I was never there," she said.

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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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Del Piero signs for second season Down Under

MELBOURNE: Italian World Cup winner Alessandro Del Piero has signed on for a second season in Australia's A-League as his Sydney FC side push for a play-off place.

"I'm very happy about this news," the Juventus and Italy legend told a press conference after agreeing to activate the second year of a reported US$2 million-a-season contract.

"For sure it's a great moment for me, for Sydney FC," he said, thanking the club for trusting him.

The 38-year-old said he would not carry on if he could not play at a high level.

"In my age, I want to be very honest. We have to see year by year."

Del Piero has already scored 11 goals in 18 matches, a record haul by a Sydney FC player in a single season and been a hit off the pitch too, helping to boost crowds, shirt sales and television ratings.

Sydney FC has fought back from the bottom of the league to fifth place -- within reach of qualification for the playoffs, largely thanks to Del Piero's goals.

"We have a good position but it's not enough, we have six games remaining but we have to push our energy to take a play-off," he said.

"We want to improve for the next year and do better and better every week," he added.

The team's charge for the finals gathered steam, with a 2-1 win over Adelaide United following the signing of Socceroos captain Lucas Neill on Saturday.

An early-season collapse was halted by the December arrival of former Australia coach Frank Farina, quickly turning Sydney FC into the form team.

- AFP/sf

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Day 2 of nationwide strike: Cops on alert in Noida; several states affected

NEW DELHI: Normal life in several parts of the country continued to remain affected on Day 2 of the nationwide strike called by the trade unions.

Cops in Noida are on high alert, after widespread violence on the first day of the strike. According to TV reports, several schools and offices in Noida have been closed.

The UP government has formed a two-member panel to probe the violence in Noida on the first day of the two-day nationwide shutdown.

The state government late on Wednesday named additional director general of police (Law and Order) Arun Kumar and home secretary Rakesh as members of the probe committee and asked them to submit a fact finding report within three days.

Principal secretary (Home) RM Srivastava told IANS that "toughest action" would be taken against those found guilty of violence.

The committee has been asked to look into the state of preparedness of the Noida police to handle the shutdown and identify district officials guilty of dereliction of duty.

"The government has taken a serious note of the whole episode, wherein properties were gutted, people were beaten up and several vehicles were set on fire. There should be no doubt that the government would crack down on all found guilty," Srivastava said.

Violence erupted on Wednesday in Noida and Greater Noida where factories were targeted and set on fire. Violent clashes took place and several vehicles were set afire.

Officials have started screening the video footage of the violence in order to identify and book the perpetrators.

"We are also exploring possibilities of slapping the National Security Act (NSA) on the rioters," a senior official said.

State government sources said chief minister Akhilesh Yadav was particularly miffed at the Noida violence as he views it as a big blow to his efforts to create a pro-investment climate in Uttar Pradesh.

"The chief minister has taken a serious note of the clashes as it could send a wrong signal that industries are not safe in UP," an official said.

Bank operations hit

Normal banking operations were hit for the second day on Thursday as public sector bank employees continued their strike.

It is, however, business as usual at private sector banks like ICICI Bank and HDFC Bank.

Employees of public sector insurance companies, including LIC and New India Assurance, are also participating in the strike.

Shutdown in Kerala

In Kerala, workers from most sectors ranging from transport to banking keeping away from work.

Reports from across the state said buses and taxis were off the roads and markets remained shut. Train and air services were not affected.

Attendance in government offices was thin and educational institutions remained closed as pro-Left service and teachers unions joined the strike. Universities have cancelled examinations scheduled for the last two days.

Barring stray incidents of minor violence, the state has remained peaceful since Wednesday.

Police in their vehicles facilitated the short-distance travels of train and air passengers, who arrived in the state unaware of the hartal atmosphere.

Emergency services like healthcare, milk supply and media have been exempted from the strike.

Schools, colleges closed in Karnataka

The two-day nationwide strike by trade unions had no major impact in most parts of Karnataka on Thursday.

Though banking services were hit, many buses, taxis and autos plied and shops and hotels remained opened here. However, schools and colleges were closed.

No violence was reported from any part of the state, police said.

Services at many hospitals in the city were not hit, as also in IT companies. Several PSUs including HAL, BHEL and BEL, besides a host of other industrial units in Bangalore were functioning normally.
No impact in Mangalore

In Mangalore, however, there has been no effect of strike on Day 2. The buses are plying normally and the schools are functioning as usual.

(With inputs from PTI, IANS)

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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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Former Navy SEAL on Coming Out of Shadows

It used to be that Navy SEALs didn't just operate in the shadows. They trained in them too. Their whole story stayed shrouded in mystery. Their secret missions stayed secret to the rest of us.

But when they got Osama Bin Laden, snatched back an American cargo ship taken by pirates and rescued two air workers held hostage in Somalia, then suddenly, it seemed that SEALs were headline-makers.

Add to that some SEALs wrote books about SEAL adventures and even acted in a movie about the SEAL experience using live ammunition when they made "Act of Valor." They can't quite be called "the military unit that no one ever talked about" any longer.

Watch the full story on "Nightline" TONIGHT at 12:35 a.m. ET

Rorke Denver played Lt. Commander Rorke in "Act of Valor," a film that used dozens of SEALs and went on to gross $80 million at the box office. Now, with the help of a writer, Denver is doing some pretty decent storytelling in a new book, "Damn Few: Making the Modern SEAL Warrior."

He agrees that with SEALs like him telling their stories that these guys are out in the open like never before.

"We are, at this moment in our history, when the heat is on, the missions are getting press and coverage," Denver said.

Acts of Valor: Four Boyfriends Took Bullets to Save Girlfriends Watch Video

'Zero Dark Thirty' Screenwriter Responds to Film's Controversy Watch Video

When asked if it was a good thing, he said, "time will tell."

"We are in the public eye and I think that mythology is something that people are hugely, hugely interested in and they have an appetite for it," Denver said. "So for us with the movie and then also with 'Damn Few' I had an opportunity, I feel, to authentically represent and hopefully do it from an honorable point of view and accurately do so."

It's mostly his own story Denver tells in "Damn Few," how he joined the SEALs after college -- they didn't want him at first.

"I put in my first application and they said no, and I am glad it went that way. I think the community really values resiliency and toughness and focus and a 'never quit' attitude. For me, when they said no I thought, that ain't going to cut it."

Denver didn't quit. He reapplied and went on to survive the SEALs brutal Hell Week and training, joined the team and deployed all over the world, including the deadly Al Anbar province in Iraq when the war there was at its hottest. His family waited for him to return stateside.

"The families, I feel, are the ones who pay the price of our choices," Denver said. "But I didn't appreciate how much I was asking my family to bear and experience it with me. They really are every bit a part of our experience and frankly they are the ones who are back home and praying and believing that you are going to come home."

But even his family didn't quite know what Denver did at work every day.

"I never ask questions about what he does," said his wife, Tracy.

But "Act of Valor" was revealing in that way, and Denver's wife watched the film.

"For me it was incredibly eye-opening to actually see a submarine mission or running around in the jungle, jumping out of a plane, shooting his weapons," she said. "For me, it was like, oh, so this is what you are doing when you are away. I appreciated it actually."

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Tunisian PM quits after failing to form new government

TUNIS (Reuters) - Tunisian Prime Minister Hamadi Jebali resigned on Tuesday after failing to replace a government pulled apart by acrimony between his Islamist allies and their secular opponents.

Jebali had threatened to quit if his plan for a non-partisan cabinet of technocrats to lead the north African country into early elections foundered.

In the end it was his own party, Ennahda, that rejected the proposal, prolonging the political stand-off that has cast a shadow over Tunisia's fledgling democracy and deepened an economic crisis.

"I vowed that if my initiative did not succeed, I would resign and ... I have already done so," Jebali told a news conference after meeting with President Moncef Marzouki.

Tunisia's deepest political crisis since the 2011 Arab Spring uprising that toppled President Zine El Abidine Ben Ali began when leading secular opposition politician Chokri Belaid was gunned down outside his home in Tunis on February 6.

No one claimed responsibility for the killing, but it deepened the misgivings of secularists who believe Jebali's government has failed to deal firmly enough with religious extremists threatening the country's stability.

Protesters poured onto the streets in the following days and Marzouki's secularist party threatened to quit the coalition government.

Jebali said he would try to form a cabinet of apolitical technocrats to restore calm and take Tunisia to elections, but did not consult his Ennahda allies or their secular coalition partners before making the proposal.

Several secular politicians backed the plan but Ennahda, winner of most parliamentary seats in elections that followed Ben Ali's overthrow, opposed the idea, fearing it would be sidelined from power.

Jebali bet his own job on the outcome, saying he would quit if he was rebuffed, and lost.

He quits 15 months into the job, although political experts said Marzouki was likely to re-appoint him as caretaker premier before a new leader is appointed.

Ennahda leader Rached Ghannouchi has said he wants to see Jebali head a new coalition. President Marzouki was due to meet Ghannouchi on Wednesday to ask him to name a prime minister.

But Jebali, announcing his resignation late on Tuesday, said he would not lead another government without assurances on the timing of fresh elections and a new constitution.

No government would be viable without Ennahda's blessing given its strength in parliament.

Ghannouchi has said it is essential that Islamists and secular parties share power now and in the future, and that his party was willing to compromise over control of important ministries such as foreign affairs, justice and interior.

"Ennahda is in negotiations with political parties to form a national coalition government", said Fethi Ayadi, a senior Ennahda official.

Iyed Dahmani, a leader of the secular Republican Party, said some kind of agreement was vital.

"We are in real trouble, politically and economically," he said.

The crisis has disrupted efforts to revitalize an economy hit hard by the disorder that followed the overthrow of veteran strongman Ben Ali.

Tunisia has been negotiating with the International Monetary Fund for a $1.78 billion loan and politicians said Jebali's inability to re-establish a functioning government had slowed efforts to restore normality.

Credit rating service Standard and Poor's said on Tuesday it had lowered its long-term foreign and local currency sovereign credit rating on Tunisia, citing "a risk that the political situation could deteriorate further amid a worsening fiscal, external and economic outlook".

(Reporting By Tarek Amara; Editing by Tom Pfeiffer)

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Swimming: Trickett urges healing after "toxic" Games

SYDNEY: Australian swimmer Libby Trickett called for healing within the sport after reports exposed a "toxic" atmosphere at the London Olympics including drunkenness, deceit and bullying.

Swimming Australia has vowed to restore its standing with the public after the country's much vaunted swimmers disappointed at the 2012 Olympics and inquiries into its culture revealed discipline was loose and the squad lacked leadership.

Trickett, who has won four gold medals at three Olympics, welcomed the news that officials would further investigate allegations against the team, including that some athletes misused prescription drugs as a prank in London.

"That issue has been left unresolved and it needs to be dealt with in order for us to move on," she told the Australian newspaper.

"It probably has gone too long without being dealt with. It certainly does need to be addressed because... if we let this one go, it's a precedent for the future."

She said all swimmers had been "under a cloud" because no individuals had so far been named.

"But if names are named, we will need to support them through the difficult times that lie ahead for them -- and they will be difficult," she said, The Australian reported.

"We need to come together again as a team and what better way to do that than by embracing these swimmers?"

Australia endured its worst swimming haul in decades in London, winning just one gold medal, six silver and three bronze for its lowest tally in the pool since Barcelona in 1992.

The lacklustre performance, in which no individual swimming gold medal was won for the first time since the 1976 Montreal Games, resulted in the commissioning of two independent reports released on Tuesday.

They revealed that morale within the swimming team was so low one athlete referred to London as the "lonely Olympics" as individuals looked after themselves ahead of the team.

- AFP/al

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Britain's Cameron visits Jallianwala Bagh massacre site, Golden Temple

AMRITSAR: British Prime Minister David Cameron laid a wreath on Wednesday at a memorial for the notorious Jallianwala Bagh massacre where he is reportedly set to express regret for the loss of life.

Cameron, dressed in a dark suit and bowing his head, laid the flowers at the Jallianwala Bagh memorial in Amritsar, where hundreds of unarmed protesters were gunned down by British troops in 1919.

Earlier, he paid obeisance at the holiest shrine of Sikh religion Golden Temple where he was presented a robe of honour.

Amid tight security arrangements, Cameron paid obeisance inside the sanctum sanctorum at 10:25am.

Clad in a dark suit and a tie with head covered with a blue-coloured cloth, Cameron was presented a robe of honour inside the sanctum sanctorum of Harmandir Sahib, popularly known as the Golden Temple.

The British prime minister also mingled with a couple of devotees and chatted with them for a brief period as Gurbani played in the backdrop. This is the first visit by a high-profile British dignitary to Amritsar after 1997, when Queen Elizabeth II and her husband Prince Philip, the Duke of Edinburgh, had visited the holy City.

Inside the temple, he was accompanied by Punjab chief minister Parkash Singh Badal, who earlier received the British dignitary at the Sri Guru Ram Dasji International Airport, Shiromani Gurdwara Prabandhak Committee (SGPC) President Avtar Singh Makkar, among others.

The British prime minister reached the Golden Temple at about 9:50am and spend nearly an hour inside.

Before paying obeisance by bowing his head inside the sanctum sanctorum, the British leader was taken around the temple by officials of the SGPC, apex religious body of the Sikhs, and was also shown Shri Guru Ram Dass Langar Hall.

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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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