Barbed versus Non-Barbed Sutures for Prevention of Surgical Site Infections in Orthopedic Surgery: A Meta-Analysis of Randomized Controlled Trials

Objective This meta-analysis aims to assess whether barbed sutures (BS) are superior to non-barbed sutures (NBS) in reducing surgical site infections (SSIs) in orthopedic surgery. Methods A systematic literature search was conducted in PubMed, Embase, Cochrane Library, and Web of Science up to October 2025. A total of 1,309 patients from eight randomized controlled trials (RCTs) were included, with 652 patients in the BS group and 657 in the NBS group. The primary outcome was the incidence of SSI, defined according to the Centers for Disease Control and Prevention (CDC) criteria where feasible. Results The pooled analysis showed no statistically significant difference in the risk of SSIs between the BS and NBS groups (RR = 0.88, 95% CI: 0.42 to 1.82, P = 0.72), with the point estimate suggesting a non-significant trend favoring barbed sutures. Similarly, there was no significant difference in the risk of wound dehiscence (RR = 0.37, 95% CI: 0.08 to 1.64). Conclusion Based on current evidence, barbed sutures do not significantly reduce the incidence of SSIs or wound dehiscence compared to non-barbed sutures in orthopedic surgery. Their utility appears to be primarily in improving operative efficiency rather than in preventing infection.