Eighty-three knees with knee osteoarthritis (KOA) undergoing total knee arthroplasty (TKA) were randomized to receive skin closure with barbed sutures (n=44) or interrupted sutures (n=39). The primary outcomes of interest were cosmetic wound outcomes measured using the Patient Scar Assessment Scale (PSAS) and wound-related complications at one year postoperatively. Secondary outcomes included patient-reported outcome measures (PROMs), specifically the Knee Society Score 2011 (KSS-2011) and the Forgotten Joint Score-12 (FJS-12), as well as the correlation between cosmetic outcomes and PROMs. Outcomes were assessed at one year after surgery. Overall, the results of the study revealed that the barbed suture group demonstrated significantly better PSAS scores, including lower pain, stiffness, and total scar scores compared with the interrupted suture group. Cosmetic outcomes were also negatively correlated with PROM scores, indicating that better scar appearance was associated with improved patient-reported knee outcomes. These findings suggest that barbed sutures may enhance patient-perceived wound healing and satisfaction following TKA.