Abstract Background: Knee osteoarthritis (KOA) significantly impairs functional capacity and independence in geriatric populations, with increased susceptibility to falls and reduced quality of life. While both neuromuscular re-education (NMR) and conventional strengthening (CS) have demonstrated efficacy, comparative evidence remains limited. Objective: This randomized controlled trial (RCT) compared the effectiveness of neuromuscular re-education versus conventional strengthening protocols on sensorimotor control, dynamic knee stability, pain modulation, gait performance, and fall risk in geriatric patients with knee osteoarthritis. Methods: Ninety-six community-dwelling adults aged 65-82 years with radiologically confirmed mild to moderate knee osteoarthritis were randomly allocated to either the NMR group (n=48) or CS group (n=48). Both groups received 12 weeks of supervised intervention (3 sessions/ week). Primary outcome measures included sensorimotor control (assessed via dynamic postural stability test), dynamic knee stability (measured by Y-Balance Test), pain (Visual Analog Scale), gait performance (10-meter walk test), and fall risk (Timed Up and Go test, Falls Efficacy Scale International). Secondary measures included knee range of motion, quadriceps and hamstring strength, and patient-reported outcomes (WOMAC Index, EuroQoL-5D). Results: Both interventions resulted in significant improvements across all outcome measures (p<0.001). However, the NMR group demonstrated significantly superior improvements in sensorimotor control (mean difference: 8.3 cm; 95% CI: 5.2-11.4), dynamic knee stability Y-Balance Test composite score (6.7 cm; 95% CI: 4.1-9.3), pain reduction (3.2 points; 95% CI: 2.1-4.3), and fall risk mitigation (TUG reduction: 2.8 seconds; 95% CI: 2.1-3.5) compared to conventional strengthening. Gait performance improvements were comparable between groups (p=0.187). Quality of life improvements favored NMR at 12-week follow-up (p=0.042). Conclusion: Neuromuscular re-education demonstrates superior effectiveness compared to conventional strengthening in ameliorating sensorimotor deficits, enhancing dynamic knee stability, reducing pain perception, and decreasing fall risk in geriatric patients with knee osteoarthritis. These findings suggest that sensorimotor training targeting proprioceptive enhancement and functional joint stabilization should be prioritized in rehabilitation protocols for this vulnerable population.