American Idol: Women Face Sudden-Death Round

American Idol

By Jamie Bufalino

02/20/2013 at 11:00 PM EST

Mariah Carey

Mario Anzuoni/Reuters/Landov

American Idol threw yet another new twist at its 40 remaining contestants: a sudden-death round.

"One song, one chance, no mercy," Ryan Seacrest said as the first group of 10 female contestants gathered in Las Vegas to try to finally sing their way – in front of a boisterous studio audience – through to the "America votes" phase of the competition.

Five women moved on, five went home.

Kentucky high school junior Jenny Beth Willis, whose rendition of a Trisha Yearwood song earned mixed reviews from the judges, was the first up. Although Keith Urban appreciated her "effortless confidence," Nicki Minaj said her performance lacked excitement (a comment that elicited the first audience boos of the season). Final result: It was the end of the road for Willis.

Tenna Torres, 28, – who attended Mariah Carey's camp for kids as a youngster – took the stage next and impressed the judges with her take on the Natasha Bedingfield's "Soulmate." But she lost style points with Minaj, who didn't like one particular aspect of her look. "Lose the hair," said Minaj, who felt the contestant's coif aged her. Final result: She made it through to the Top 20.

The three most powerful performances of the night all made it to the next round: Nashville's Kree Harrison, who despite taking a decidedly plain-Jane approach to styling, wowed the judges with her version of Patty Griffin's "Up to the Mountain." "You sang the hell out of that song," said Carey.

Angela Miller, 18, of Massachusetts, belted out Jessie J's hit "Nobody's Perfect." But she pretty much was.

And Amber Holcomb, an assistant teacher from Texas, closed the show with a rousing (and well received) rendition of "My Funny Valentine."

For the final spot of the night, it came down to Anchorage, Alaska, resident Adriana Latonio, 17, who tackled Aretha Franklin's "Ain't No Way," and Shubha Vedula, a Michigan high school senior who sang Lady Gaga's "Born This Way."

Although the judges saw potential in both contestants, they ultimately picked Lantonio's powerhouse vocals in a final emotional moment.

Thursday will bring out the guys. The first round of 10 will take the stage to try to make the top 20 – but once again, five will go home.

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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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Bell trial's closing arguments marked by anger and passion

During closing statements that were both impassioned and scornful, the prosecution presented the six former City Council members accused in the Bell corruption trial as thieves who fleeced a small, working-class town, while the defense portrayed them as hard-working public servants dedicated to their community.

Deputy Dist. Atty. Edward Miller took aim at the defendants, saying that instead of serving their low-income constituents, they were more interested in fattening their wallets.

"I'm talking about taking big money — money from poor people, money from tenants in low-income housing," he said.

As the four-week trial in the municipal corruption case winds down, the case will probably go to the jury late this week. Luis Artiga, Victor Bello, George Cole, Oscar Hernandez, Teresa Jacobo and George Mirabal are accused of misappropriating city funds by drawing annual salaries of up to $100,000 for work on city boards that seldom met and did little work.

Miller lambasted the defendants' work on four city authorities, and said the dozens of documents shown throughout the trial — including resolutions for pay raises — were "the instruments by which they stole $1.3 million from the citizens of Bell — proof that the pen is mightier than the sword when it comes to white-collar crime."

During his 77-minute statement, Miller tore down each defendant.

Talking about Cole, who testified that he had voted for a 12% annual raise because he feared then-City Administrator Robert Rizzo, Miller said: "Boy, I sure wish my boss would threaten me with a raise."

Miller called Bello's work with the food bank, a job he was given after resigning from the council, a scam.

"Every time one of the recipients looked at him as an angel of mercy, they were actually looking at nothing more than a charlatan, a fake, a phony, a $100,000-a-year volunteer," he said.

Mirabal, he said, had been city clerk, Jacobo a real estate agent and Hernandez a grocery store owner.

"They just weren't 'yes men,' except when it came to pay raises for themselves," he said.

Artiga, a church pastor who was appointed to the council in 2008 when Cole resigned, had a responsibility to determine the appropriateness of his salary, Miller said.

Defense attorneys shot back, reminding jurors that witnesses had testified that their clients worked tirelessly for the community. The defendants, attorneys said, relied on experts who never waved a red flag over the salaries.

Jacobo's attorney, Shepard Kopp, brought up his client's testimony that Rizzo and City Atty. Edward Lee said her pay raise would be legal.

Kopp also questioned why Lee wasn't called as a prosecution witness. "He either drafted or reviewed every single one of these resolutions that raised their pay. He never said a word to Ms. Jacobo or anyone else there was a problem with it."

Kopp argued that although state law fixed salaries for the Bell Community Housing Authority at a maximum of $50 for each of four meetings a month, that did not include payment for work outside meetings.

The prosecution, Kopp said, has "been focused only on the meetings and that's not where the work is done."

Ronald Kaye, Cole's attorney, said nothing had proved that his client believed his pay for the authorities was more than an accounting and bookkeeping procedure.

Kaye imitated Miller's voice and attacked the prosecutor for offering "misleading" evidence. He also referred to Rizzo as "a vindictive control freak."

The defense attorney made a final plea for his client: "They can defame him. They can falsely arrest him. They can destroy his reputation. They can haul him into court.... But this prosecutor does not control his fate anymore.

"Go back to that jury room and give George Cole back his life."

Closing arguments will continue Thursday.

jeff.gottlieb@latimes.com

corina.knoll@latimes.com

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Pistorius Denies Murdering Girlfriend

Siphiwe Sibeko/Reuters

Oscar Pistorius wept at a hearing on Tuesday seeking bail.

PRETORIA, South Africa — Early on Feb. 14, Oscar Pistorius says, he heard a strange noise coming from inside his bathroom, climbed out of bed, grabbed his 9-millimeter pistol, hobbled on his stumps to the door and fired four shots.

“I fail to understand how I could be charged with murder, let alone premeditated,” Mr. Pistorius said in an affidavit read Tuesday to a packed courtroom by his defense lawyer, Barry Roux. “I had no intention to kill my girlfriend.”

Prosecutors painted a far different picture, one of a calculated killer, a world-renowned athlete who had the presence of mind and calm to strap on his prosthetic legs, walk 20 feet to the bathroom door and open fire as his girlfriend, Reeva Steenkamp, cowered inside, behind a locked door.

“The applicant shot and killed an unarmed, innocent women,” Gerrie Nel, the chief prosecutor, said in court on Tuesday. That, Mr. Nel argued, amounted to premeditated murder, a charge that could send Mr. Pistorius to prison for life.

In court, Mr. Pistorius, a Paralympic track star who competed against able-bodied athletes at the London Olympics despite having lost both his lower legs as an infant, wept uncontrollably as Mr. Roux gave the runner’s account of the fateful early morning. At one point, Magistrate Desmond Nair called a recess to allow Mr. Pistorius, who was sobbing loudly, his face contorted, to regain his composure.

“My compassion as a human being does not allow me to just sit here,” Magistrate Nair said.

As the defense and prosecution laid out their competing versions of the shooting, some details were beyond dispute.

Mr. Pistorius and Ms. Steenkamp were alone in the house, having spent the evening there. Around 3 a.m., Mr. Pistorius shot Ms. Steenkamp through the bathroom door, fatally wounding her. He broke down the door and carried her down the stairs, where she died in the foyer of his upscale home in a highly secured compound.

The young woman, a model, was cremated Tuesday on the other side of the country in her hometown, Port Elizabeth. Her family and friends mourned her and called for the authorities to deal harshly with Mr. Pistorius.

“There’s a space missing inside all the people that she knew that can’t be filled again,” her brother, Adam Steenkamp, told reporters after the memorial service.

In court, Mr. Pistorius is seeking bail on the charge of premeditated murder, but he faces an uphill battle. Magistrate Nair ruled Tuesday that the case would be treated as the most serious kind of offense, which means bail will be granted only if the defense can prove extraordinary circumstances requiring it.

The court proceedings, though they concerned only whether Mr. Pistorius would receive bail, offered the first real glimpse into what unfolded at his home on the day of the shooting.

In his affidavit, Mr. Pistorius said that he and Ms. Steenkamp had decided to stay in for the night. He canceled plans with his friends for a night on the town in Johannesburg, while she opted against movies with one of her friends. They had a quiet evening, he said. She did yoga. He watched television. About 10 p.m., they went to sleep.

In the early morning hours, he said, he woke up to move a fan from the balcony and to close the sliding doors in the bedroom.

“I heard a noise in the bathroom and realized that someone was in the bathroom,” he said. “I felt a sense of terror rushing over me.”

He had already said in the affidavit that he feared South Africa’s rampant violent crime, and later added that he was worried because there were no bars on the window to the bathroom. Construction workers had left ladders in his garden, he said.

“I believed someone had entered my house,” he said in the affidavit. “I grabbed my 9-millimeter pistol from underneath my bed. On my way to the bathroom I screamed words to the effect for him/them to get out of my house and for Reeva to phone the police. It was pitch dark in the bedroom, and I thought Reeva was in bed.”

Walking on his stumps, he heard the sound of movement inside the toilet, a small room within the bathroom.

Alan Cowell contributed reporting from London.

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What's Next for Mindy McCready's Two Young Boys?

By Steve Helling

02/19/2013 at 07:00 PM EST

Mindy McCready's apparent suicide on Sunday has left her two young sons in custodial limbo.

The boys – Zander, 6, and Zayne, 10 months – had been in state custody since Feb. 7, when McCready called police to ask for help in making her father and stepmother leave her home. When police arrived, McCready appeared to be intoxicated, according to a Department of Human Services report.

In a subsequent petition, the singer's father, Tim McCready, asked the court to order her to undergo mental health and substance abuse evaluation and treatment, alleging that his daughter, who had recently lost her boyfriend, "hasn't had a bath in a week ... screams about everything ... [is] very verbally abusive to Zander."

After a judge granted the petition, the children were quickly removed and placed into foster care. Although McCready was released from treatment, the boys remained in state custody.

At the time, Zander's father, Billy McKnight, requested custody of his son. "My son needs me," he told PEOPLE on Feb. 8. "I'm married, working and successful. I'm on the right track and proud of it. I've been sober for years. I just want my son."

But McCready's mother and stepfather, Gayle and Michael Inge, also want custody of the children – and authorities seem to agree.

In a proposed order sent to Circuit Judge Lee Harrod, the Department of Human Services proposed that the Inges might be a better fit for the children, claiming that they have "a substantial relationship." The Inges had custody of Zander for much the past few years, during McCready’s rehab and jail stints.

With McCready's death, the judge will have to determine what is in the children's best interest. A custody hearing has been scheduled for April 5.

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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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O.C. shootings leave four dead, many questions

The rampage began just as the morning commute was getting underway.

Over the course of about an hour, authorities say, a 20-year-old college student killed a woman at his Ladera Ranch home and embarked on a string of shootings that stretched through the heart of Orange County, targeting random people during their morning routines.

He carjacked a truck at a gas station, police said, then executed a businessman and stole his BMW. A few minutes later, he killed a plumber and took a work truck. He shot indiscriminately at morning commuters on the 55 Freeway, hitting at least three cars.

In the end, authorities say the gunman killed three people and wounded three others before fatally turning his gun on himself.

Authorities were stunned by what they described as the "senseless violence," which spanned about 25 miles of normally placid suburbia. The gunman, identified as Ali Syed, had no criminal record and left few clues as to any motive, police said.

"I just killed someone," he told one man during the rampage, according to police. "This is my last day."

Police discovered the first victim early Tuesday at a beige-and-white stucco condo in an upscale Ladera Ranch community. Syed, who was unemployed and enrolled in a class at Saddleback College, lived there with his parents.

Neighbor Jason Glass said he heard three to five loud bangs in the early morning. He heard doors slam, then a car sped away from the house.

"I just thought somebody was being really loud and obnoxious," Glass said.

Deputies arrived at the neighborhood of doctors and lawyers about 4:45 a.m., after Syed's parents called 911.

Authorities found the body of a woman in her 20s who'd been shot multiple times. She was not related to Syed, authorities said. As of Tuesday evening, it remained unclear who she was and why she was at his home.

Meanwhile, Syed had taken off in the family's black GMC Yukon, armed with at least one shotgun, authorities said. Possibly in his haste to flee, police said, he damaged the vehicle.

He exited Interstate 5 at Red Hill Avenue in Tustin about 5 a.m. and pulled into a Denny's parking lot. There, a man was sitting in an older-model blue Cadillac, waiting for his son. They'd planned to carpool to work.

Police said the gunman pointed his weapon at the man and yelled "Get out." Instead the man sped away and Syed fired, shattering the Cadillac's rear window and striking the man in the back of the head. The man kept going — he was later treated at a hospital — and the gunman dashed to a nearby Mobil station, authorities said, where he spotted a man pumping gas.

"When they made eye contact, Syed started running toward the victim," said Tustin Police Chief Scott Jordan. "He said to him, 'I don't want to hurt you. I just killed someone. Give me your keys. This is my last day.'"

The man obliged.

Syed took the man's Dodge pickup and headed north on Interstate 5, authorities said. After merging onto the southbound 55 Freeway, he stopped on the shoulder, got out of the truck and opened fire on the cars speeding by, hitting at least three. One driver was injured by flying glass.

Santa Ana Police Cpl. Anthony Bertagna said the gunman may have realized that the pickup was low on fuel and was trying to steal a second vehicle.

Damita Cunningham was driving on the 55 Freeway about 5:20 a.m. when traffic suddenly halted. She put her Honda Accord in reverse, thinking she could go around the accident, but a large vehicle backed into her and drove away.

Cunningham followed the vehicle, which pulled off the freeway. She walked over to the driver, whom she described as "sitting there with a blank stare." He told her a man had pointed a gun at his window. He had been trying to flee.

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China’s Army Is Seen as Tied to Hacking Against U.S.

This 12-story building on the outskirts of Shanghai is the headquarters of Unit 61398 of the People’s Liberation Army. China’s defense ministry has denied that it is responsible for initiating digital attacks.

On the outskirts of Shanghai, in a run-down neighborhood dominated by a 12-story white office tower, sits a People’s Liberation Army base for China’s growing corps of cyberwarriors.

The building off Datong Road, surrounded by restaurants, massage parlors and a wine importer, is the headquarters of P.L.A. Unit 61398. A growing body of digital forensic evidence — confirmed by American intelligence officials who say they have tapped into the activity of the army unit for years — leaves little doubt that an overwhelming percentage of the attacks on American corporations, organizations and government agencies originate in and around the white tower.

An unusually detailed 60-page study, to be released Tuesday by Mandiant, an American computer security firm, tracks for the first time individual members of the most sophisticated of the Chinese hacking groups — known to many of its victims in the United States as “Comment Crew” or “Shanghai Group” — to the doorstep of the military unit’s headquarters. The firm was not able to place the hackers inside the 12-story building, but makes a case there is no other plausible explanation for why so many attacks come out of one comparatively small area.

“Either they are coming from inside Unit 61398,” said Kevin Mandia, the founder and chief executive of Mandiant, in an interview last week, “or the people who run the most-controlled, most-monitored Internet networks in the world are clueless about thousands of people generating attacks from this one neighborhood.”

Other security firms that have tracked “Comment Crew” say they also believe the group is state-sponsored, and a recent classified National Intelligence Estimate, issued as a consensus document for all 16 of the United States intelligence agencies, makes a strong case that many of these hacking groups are either run by army officers or are contractors working for commands like Unit 61398, according to officials with knowledge of its classified content.

Mandiant provided an advance copy of its report to The New York Times, saying it hoped to “bring visibility to the issues addressed in the report.” Times reporters then tested the conclusions with other experts, both inside and outside government, who have examined links between the hacking groups and the army (Mandiant was hired by The New York Times Company to investigate a sophisticated Chinese-origin attack on its news operations, but concluded it was not the work of Comment Crew, but another Chinese group. The firm is not currently working for the Times Company but it is in discussions about a business relationship.)

While Comment Crew has drained terabytes of data from companies like Coca-Cola, increasingly its focus is on companies involved in the critical infrastructure of the United States — its electrical power grid, gas lines and waterworks. According to the security researchers, one target was a company with remote access to more than 60 percent of oil and gas pipelines in North America. The unit was also among those that attacked the computer security firm RSA, whose computer codes protect confidential corporate and government databases.

Contacted Monday, officials at the Chinese embassy in Washington again insisted that their government does not engage in computer hacking, and that such activity is illegal. They describe China itself as a victim of computer hacking, and point out, accurately, that there are many hacking groups inside the United States. But in recent years the Chinese attacks have grown significantly, security researchers say. Mandiant has detected more than 140 Comment Crew intrusions since 2006. American intelligence agencies and private security firms that track many of the 20 or so other Chinese groups every day say those groups appear to be contractors with links to the unit.

While the unit’s existence and operations are considered a Chinese state secret, Representative Mike Rogers of Michigan, the Republican chairman of the House Intelligence Committee, said in an interview that the Mandiant report was “completely consistent with the type of activity the Intelligence Committee has been seeing for some time.”

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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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