Barbed Suture Applications in Orthopedic Surgery

Barbed sutures are knotless wound-closure devices featuring unidirectional or bidirectional barbs along the filament. First conceived in the mid-20th century, they have seen progressive refinement in material composition and barb geometry to meet the demands of high-tension orthopaedic repairs. By obviating knot tying, these sutures distribute tensile forces more evenly along the incision, reduce operative time and eliminate bulk from knot stacks. Their use has proliferated in hip and knee arthroplasty, soft-tissue repair and joint capsule closure, where rapid, reliable closure is critical to reduce infection risk, facilitate early mobilisation and improve cosmetic outcome. Global adoption has been driven by evidence of cost savings, standardisation of multilayer closure techniques and integration with topical adhesives to achieve watertight seals.

Research from Nature Portfolio

Recent studies have reinforced the efficacy of barbed sutures in major joint arthroplasty. A seminal meta-analysis of knee arthroplasty demonstrated that barbed, knotless sutures reduce wound-closure and overall operating time without increasing complication or infection rates, and may lower the risk of arthrotomy-related events. A comprehensive review of randomised trials across multiple surgical disciplines confirmed that knotless barbed designs significantly shorten both suture placement and total operative times, although safety profiles remain dependent on specific suture type and surgical context. More recently, comparative data in total hip arthroplasty have shown that a barbed continuous suture technique can cut fascial closure time by nearly six minutes while preserving haemostasis, transfusion rates and wound-complication rates equivalent to conventional interrupted sutures.

Barbed Suture Applications in Orthopedic Surgery publication trend

The graph below shows the total number of articles in barbed suture applications in orthopedic surgery across all publications each year (not limited to Nature Index journals).

Technical terms

Barbed suture: Self-anchoring, knotless suture with microscopic barbs that engage tissue to maintain approximation without knots.

Arthrotomy: Surgical incision into a joint capsule to allow access for prosthetic implantation or soft-tissue repair.

Fascial closure: Suturing the fascia, the connective tissue layer overlying muscle, to restore structural integrity.

Subcuticular suture: Continuous or interrupted sutures placed within the dermal layer immediately beneath the epidermis for cosmetic skin edge approximation.

Watertight closure: Technique designed to prevent leakage of fluid or blood through the wound, often achieved by multilayer suturing and adjunctive adhesives.

References

1. Barbed sutures and skin adhesives improve wound closure in hip and knee arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy (2024).
2. A Review of Barbed Sutures—Evolution, Applications and Clinical Significance. Bioengineering (2023).
3. Barbed versus traditional sutures for wound closure in knee arthroplasty: a systematic review and meta-analysis. Scientific Reports (2016).
4. The Efficacy and Safety of Knotless Barbed Sutures in the Surgical Field: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Scientific Reports (2016).
5. A comparison of barbed continuous suture versus conventional interrupted suture for fascial closure in total hip arthroplasty. Scientific Reports (2022).
6. Multilayer Watertight Closure to Address Adverse Events From Primary Total Knee and Hip Arthroplasty: A Systematic Review of Wound Closure Methods by Tissue Layer. Arthroplasty Today (2021).