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Although total knee arthroplasty (TKA) is a common treatment for severe osteoarthritis, high risks of fall and balance loss are the main complications of this procedure. While multiple rehabilitation protocols have been suggested for TKA, efficacy of early resistive exercise therapy aimed at improving balance has not yet been thoroughly investigated.In this double-blind randomized controlled trial study, 40 patients with severe osteoarthritis, sampled by a simple convenient method, were randomly assigned into either “control” group or “early resistive exercise” group. After TKA surgery, both groups attended a routine rehabilitation program while the experimental group received extra early resistive exercises. Static, semidynamic, and dynamic balance were assessed by the Sharpened Romberg (SRBT), Star Excursion (SEBT), and Berg (BBT) balance tests prior to surgery, after the rehabilitation process (seventh week), and at a 2-week later follow-up time (ninth week).At the end of the seventh and ninth weeks, in both groups all 3 balance scores were significantly enhanced comparing the baseline scores (P < .001). The experimental group had significantly higher scores than the control group in SRBT, SEBT, and BBT after the intervention and at the follow-up time (P < .001).The findings of this study showed that rehabilitation following TKA is accompanied by balance (static, semidynamic, and dynamic) improvement, and this improvement is greater among patients participating in an early resistive exercise regimen. Early progressive resistive exercise in addition to routine physical therapy may lead to better balance performance than routine physical therapy and might be incorporated into the postoperative physical therapy of these patients. Further studies with longer follow-up periods are needed to confirm these results.