50 patients undergoing bilateral total knee arthroplasty (TKA) were randomly assigned to undergo closure with knotless bidirectional barbed sutures in one knee and standard sutures in the other. The purpose of this study was to determine whether there is a superior technique in terms of clinical outcomes and cost-effectiveness. Findings of this study determined knotless bidirectional barbed sutures to be more effective for closure time and direct operative cost compared to standard sutures. However, Knee Society Scores, range of motion (ROM), and wound appearance were comparable between methods.