Knee osteoarthritis (OA) is a degenerative joint disease characterized by cartilage degradation, bone remodeling, and osteophyte formation. This causes pain, muscle weakness and impaired proprioception which leads to the poor balance and increase risk of fall. Conventional exercises improve muscle strength and reduce pain while unstable surface training enhances proprioception and joint stability. The objective was to analyze the comparative effect of unstable surface training and conventional exercises on balance in patients with knee osteoarthritis. The study was randomized clinical trial involving 32 participants, aged between 45 to 60 years, who presented with unilateral or bilateral knee osteoarthritis and has been diagnosed with grade 2 knee OA according to KellgrenLawrence classification. Patients experiencing symptoms for more than six months was recruited. Participants was randomly assigned to two groups: Group A received unstable surface training, involving squats, sit-to- stand, forward lunges, step-ups, timed single-leg stance, and wall slides on wobble board. Group B received conventional exercises including isometric strengthening and stretching exercises for the hamstrings and quadriceps. Both interventions was administered thrice a week for four weeks. Balance was assessed using the Berg Balance scale (BBS). Assessments was conducted at baseline and post- intervention, after a four-week follow-up. Statistical analysis will be performed using SPSS version 26. Normality of data was checked and for within group comparison paired t-test was used and to compare both the groups independent t- test was used. Results showed that unstable surface training was found to be more efficient than conventional exercise program. The mean value of post BBS score of both groups was compared. Post BBS score of group A was 46.25 ±4.64 while post BBS score of group B was 38.37±4.57 with mean difference of 7.88 according to the study’s findings unstable surface training is more effective in term of increasing balance in patient with knee OA.