The relationship between the surgical epicondylar axis (SEA) and the rotational axis of the distal femur remains unclear. We investigated the relationship between the SEA and the distal femur and whether the SEA can be used as the rotational axis of the knee. Angular and linear measurements of 70 femora at 0 degrees, 30 degrees, 60 degrees, 90 degrees, and 120 degrees of flexion were recorded. Results showed that the SEA was a logical and appropriate parameter as a principal axis for knee flexion at least between 0 degrees and 60 degrees of flexion. The study has important implications for the design and positioning of femoral components in total knee arthroplasty. (C) 2014 Elsevier Inc. All rights reserved.