Eighty-two elderly patients on the waiting list to undergo a primary total knee replacement (TKR) diagnosed with advanced idiopathic knee osteoarthritis (OA) were randomized to receive a pre-operative training program of combining strengthening and balance training (n=26), strengthening exercises alone (n=28), or control (n=28) under the guidance of a physiotherapist. The groups included 4 weeks of training consisting of 12 sessions (30-40 mins) each where the strengthening and balance training group received an additional 15-20 minutes of balance and proprioceptive training. Primary outcomes of interest included the following: overall balance measured using the Berg Balance Scale (BBS) and function using the activities daily living (ADL) subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS). Secondary outcomes included knee range of motion (i.e. knee flexion, knee extension) knee strength, timed up and go (TUG) test, functional reach test, single leg standing (SLS), and the KOOS subscales of symptoms, pain, and quality of life (QoL). All outcomes were assessed 1 week before surgery as well as 2, 6, and 52 weeks post-surgery. Results revealed that between 1 pre surgery to 6 weeks post-surgery, BBS and KOOS-ADL scores were not statistically significantly different across the three groups (p=0.013; p=0.16, respectively). Similarly, BBS and KOOS-ADL scores were not statistically significantly different across all three groups at 1-year follow-up (p=0.09; p=0.98, respectively). For single leg standing outcome at 1 year follow-up post-surgery, a statistically significant difference was observed between the three groups where the strengthening exercise alone and combined groups both had higher scores than the control (p=0.043).