Objectives: Describe basic differences in sutures and the overall impact on cost efficacy. Design: Review. Intervention: Suture choice. Main Outcome measurements: Cost. Results and Conclusions: It is important for a surgeon to consider the advantages of various sutures and needles to ensure proper primary approximation, prevent infection or dehiscence, and close in a time-efficient manner. Modern-day sutures can be divided into three main categories: natural vs synthetic, monofilament vs multifilament, and non-absorbable vs absorbable. A newer monofilament barbed suture has been given increasing attention, as it reduces procedural times and ultimately operative costs. Level of Evidence: IV, Review Keywords: suture, barbed, cost, orthopaedic surgery, orthopedic surgery, cost analysis (J Ortho Business 2022; Volume 2, Issue 2:pages 13-18)