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Purpose: We investigated whether the anterior border of the tibia is parallel to the tibial axis, and which position of the anterior border should be used as a landmark of the tibial axis in total knee arthroplasty. Methods: Ninety-one patients prior to total knee arthroplasty were evaluated. Electrocardiogram electrodes were placed along the anterior border at 5 cm (A), 10 cm (B), and 15 cm (C) distal to the tibial tuberosity, and an anteroposterior X-ray image was taken. The angles of the AC, AB, and BC lines on the tibial bone axis line were measured. Results: The mean angles of the AC, AB, and BC lines to the tibial bone axis line were, respectively, 1.09, 2.22, and −0.02. The percentages within −3° to +3° were 86.8, 64.8, and 92.3, respectively. Conclusions: A line connecting a point 10–15 cm distal to the tibial tuberosity can serve as a reference line for total knee arthroplasty.