Provided that the reader’s heavy alcohol intake has been confined to the past month or so, and throughout the rest of the year it was not excessive, all should be well. If he was likely to have developed an acute alcoholic hepatitis as the result of his recent drinking he would probably have done so by now. We don’t, of course, know how much he drank over the holiday when he was away from the influence of his younger friends and presumably being nurtured in the bosom of his family.

People often suggest that they won’t suffer any damage because they don’t drink for one or two days a week. They offer this as a plea of mitigation, saying something like “I don’t think I will have any liver troubles, doctor — I never drink on Wednesdays and Thursdays”.

A variation on this theme is to suggest that all will be well because they drink only in the evenings, but they omit to say how much they have after work. Others expect to achieve immunity from the less desirable effects of overindulgence by never mixing beer with spirits, spirits with wine or by sticking to some other magic formula.

Neither giving up for a couple of days a week, or drinking only at certain times of the day, makes tuppence worth of difference to the liver. What counts is the quantity of alcohol drunk, week by week, over the years. How this is divided up day by day, or during the day, is not of significance.

The liver is a processing plant that detoxifies alcohol. The success it has in performing this function, and the future health of the organ, have nothing to do with the social niceties of drinking or the timing of the drinks. The liver may be damaged if someone drinks too much, too often and for too long a time. Having two abstemious days a week would not be enough to counteract any effects on the liver’s structure of an excessive alcohol intake during the other five days. It might even have the disadvantage of making the blood rather more likely to clot during the abstinent days.

Our reader is right to talk about general health. A heavy drinking session such as the ones that our reader has with his younger colleagues could have induced acute liver damage, pancreatic problems (as, indeed, regular steady drinking can do) or cardiac arrhythmias and, in consequence, problems from a stroke. Heart attacks are also more common after a heavy bingeing session.

Nor does not mixing drinks matter. Social niceties determine who drinks what and when, but it is the palate and custom that are offended by deviating from these rules, not the liver cells. Again, it is the quantity of alcohol taken that damages organs including the liver. Being choosy about the quality and nature of what one drinks may lessen the chance of a hangover but if the alcohol content is the same, mixing drinks or not mixing them makes no difference to long-term health.

Is there any value in giving up for a month in the new year? After only three weeks’ abstinence our reader’s liver function, perhaps compromised by the pre-Christmas drinking, may be starting to return to normal. It would serve as a good start in honouring a determination to avoid keeping up with his young friends, but not much else. Hereafter he shouldn’t follow the pattern set by people 25 years younger, but should stick to his half-bottle of wine a day.

Two years ago a 66-year-old man, formerly athletic and previously active, needed a full knee replacement. After surgery and, later, further surgical intervention and intensive physiotherapy, he can play golf provided that he uses a trolley, but finds stairs difficult and is unable to ride a bicycle. He has been advised that his trouble has been caused by a tendency to create scar tissue easily, and that this has led to post-operative complications that restrict the flexibility of his knees.

Without meeting our reader or having detailed knowledge of his operation and the reasons for his tendency to produce excessive scar tissue, it is impossible to give satisfactory advice. However, his case does raise interesting points about knee joints and their replacement. Using existing methods, total knee replacement should give an excellent result in 82 per cent of cases and is likely to last longer than a hip operation. Achieving a good result is important as knees often crumble in middle age, especially in those who have destroyed their joints by excessive athletic activities. Someone under 55 subjects their knees to strains and tensions six times as great as those experienced by a 70-year-old who is beginning to slow down.

Research has shown that the secret of a good result in knee surgery is to be obsessionally precise about developing good alignment by ensuring the correct positioning of the artificial knee joint. The new alignment shouldn’t result in a change of axis of the lower limb by more than 3 per cent. Poor alignment, which in all probability has had nothing to do with the failure of this case, is a frequent cause of early trouble.

The answer to achieving success in an even higher proportion of knee replacements may lie in computer-assisted surgery. Computer-assisted alignment of the joint, so as to achieve the correct axis of the lower limb, results in a higher percentage of knee-replacement patients being left with movement as good as that of their contemporaries with natural knees.

What should be done in the case of our reader is something that only his orthopaedic surgeon can determine. Regular use of the artificial joint and physiotherapy are bound to be helpful. It is amazing how some stiff joints loosen in time.

If this doesn’t happen, or his knee begins to deteriorate, the question of revision of the surgery and another knee joint may become necessary, in which case he could think of computer-assisted surgery.

But he would also need another opinion on his tendency to make scar tissue.

Ask Dr Stuttaford

Send your questions to drstuttaford@thetimes.co.uk or to times2, The Times, 1 Pennington Street, London E98 1TT. Please include the following: the symptoms (and how long they have been present), the person’s age, sex and marital status. Dr Stuttaford’s replies cannot apply to individual cases but should be taken in a general context.