This MRI study explores the individual variation of the rotational axes of the distal femur, and investigate the relationship of this variation with overall coronal alignment in the osteoarthritic knee, The mean surgical epicondylar axis (SEA) was 1.7 degrees, anatomical epicondylar axis (AEA) 5.6 degrees and AP trochlea axis (APA) 94.3 degrees external rotation, compared to the posterior condylar line. Investigating this relationship between different coronal alignment groups, there were statistically significant differences between excessive varus and excessive valgus knees for SEA (0.9: 3.0 p < 0.001) and AEA (4.7: 7.0 p < 0.001). There was no statistical difference for APA (93.9: 95.3 p = 0.238). Crown Copyright (C) 2016 Published by Elsevier, a division of Reed Elsevier India, Pvt. Ltd on behalf of Prof. PK Surendran Memorial Education Foundation. All rights reserved.