Purpose. Exercise is regarded a cornerstone in the treatment of mild to moderate osteoarthritis (OA). However, little is known of the effects in patients with advanced and end-stage OA. The purpose was to evaluate the effect of neuromuscular exercise in patients with severe hip OA. Methods. Design. Randomized controlled trial (Clinicaltrials.gov identifier: NCT01003756). 84 patients, 51% female, mean age 68.6±7.8 years, BMI 28.7±4.7 scheduled for total hip replacement at Svendborg Community Hospital, Odense University Hospital, Denmark were included. Intervention. Participants were randomized to an eight-week neuromuscular exercise (NEMEX-TJR) intervention or care-as-usual (verbal and written preoperative information). Intervention was supervised and offered twice a week with each session lasting one hour. The program is considered feasible and safe in this patient group and previously described in detail. Assessments were carried out at baseline and within one week after the intervention. Outcomes. Functional performance: 20-m walk at maximal pace and 5 repeated chair stands timed. Muscle power: Unilateral multi-joint leg extension power and unilateral single-joint knee extension power evaluated with a leg extension press (Nottingham Power Rig, Nottingham University, Nottingham, UK) and a seated knee extension machine (Oemmebi, Moglia, Italy) adapted with a linear encoder (MuscleLab Power, Ergotest Technology, Langesund, Norway), respectively. Results. On average the intervention group attended 13±4 sessions (Table 1). In favor of the intervention group, the between-group difference was significant for 20-m walk (2.2 seconds, p=.009), chair stands (1.7 seconds, p=.022) and leg extension for the non operated leg (.17 W/kg, p=.049) (Table 2). Conclusion. Eight weeks neuromuscular exercise according to the NEMEX-TJR program improves functional performance and leg extension power in patients with severe OA of the hip joint.