Ninety-eight patients aged 70 or older with severe hip osteoarthritis were randomized to receive either a 6–12-week prehabilitation program consisting of tailored exercise and education (n=48) or usual care (n=50). The primary outcome was gait speed measured via the 40 m Fast-Paced Walk Test at 3 months post total hip replacement (THR). Secondary outcomes included performance-based tests (Chair Stand Test, Timed Up & Go Test, 6-Minute Walk Test, Stair Climb Test) and patient-reported outcomes (HOOS and EQ-5D), assessed at multiple timepoints up to 12 months postoperatively. Overall, the results of the study revealed no significant between-group differences in gait speed at 3 months or any postoperative timepoint, although prehabilitation improved gait speed and HOOS QoL scores preoperatively. The findings suggest that while prehabilitation may improve some preoperative function and quality of life, it does not enhance recovery beyond that achieved through surgery alone.