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PubMed This is a summary of 22 peer-reviewed journal articles Updated
Orthopedic Surgery · Kienböck Disease

Treatment Paths and What to Expect

At a Glance

Treatment for Kienböck disease depends entirely on your Lichtman stage. Early stages focus on saving the lunate bone using joint-leveling surgeries or bone grafts, while later stages use carpal fusion or bone removal to relieve arthritis pain and stabilize the wrist joint.

Treatment for Kienböck disease is highly specialized and depends entirely on the Lichtman Stage of your condition. The goal of treatment shifts from “saving” the lunate bone in early stages to “reconfiguring” the wrist joint in later stages to manage pain and preserve function [1][2].

Managing Pain While Waiting for Consultations

While you are waiting to finalize a surgical plan, you can protect your wrist and manage daily pain by:

  • Wearing an over-the-counter rigid wrist splint to reduce painful motion.
  • Avoiding heavy lifting, forceful gripping, or bearing weight on your hands.
  • Discussing the safe use of over-the-counter NSAIDs (like ibuprofen) with your primary care doctor to manage daily inflammation.

Early Stages (I and II): Saving the Bone

In the early phases, the lunate bone is still structurally sound enough to potentially heal. Treatment focuses on two strategies: unloading the pressure and revascularization [3][4].

  • Conservative Management: For patients with very mild pain in the earliest stages before any collapse has occurred (Stage I or early Stage II), rest and splinting may be tried [5][6]. Once mechanical collapse occurs (Stage III), surgical intervention is typically required to prevent further instability.
  • Joint-Leveling (Radial Shortening Osteotomy): This is one of the most common surgeries for Kienböck. If your forearm bones are uneven (ulnar negative variance), the surgeon removes a few millimeters from the radius bone. This “levels the foundation” and shifts up to 40% of the force away from the lunate, giving it a chance to recover [7][8].
  • Revascularization: To restart the “plumbing,” a surgeon may perform a vascularized bone graft. They move a small piece of healthy bone along with its attached blood vessel (such as a specialized blood vessel from another part of your wrist) into the lunate to restore blood flow [9][4].

The “Fork in the Road”: Stage IIIB and IIIC

When the lunate begins to collapse and causes other wrist bones to shift (Stage IIIB), or if the bone has a vertical split (Stage IIIC), the strategy moves toward stability [10][11].

  • Limited Carpal Fusion: Procedures like scaphocapitate fusion lock some of the small bones together to prevent the wrist from “sinking” or collapsing further. This provides reliable pain relief and maintains a functional—though slightly reduced—range of motion [12][13].
  • Fixation for IIIC: For a vertical (coronal) fracture, surgeons may use specialized screws to hold the lunate together alongside a joint-leveling procedure [14].

Late Stages (IV): Salvage Procedures

When the disease has caused arthritis across the entire wrist joint, “saving” the lunate is no longer possible. Instead, surgeons use salvage procedures to remove the source of the pain [15][16].

  • Proximal Row Carpectomy (PRC): The surgeon removes the first row of wrist bones (including the lunate). This creates a new, simplified joint that is often very successful at providing long-term pain relief while preserving enough movement for most daily activities [17][18].
  • Total Wrist Fusion: In cases of severe, widespread arthritis, the entire wrist is fused into one solid bone. While this eliminates bending at the wrist, it provides complete pain relief and restores a very strong grip [19].

Warning Signs of Inexperienced Care

Kienböck is rare, and many general practitioners may not be familiar with the modern “standard of care.” Be alert if a care team:

  1. Relies only on X-rays: If you have persistent pain, a “normal” X-ray is not enough. You must have an MRI to check for early-stage disease [20].
  2. Suggests “wait and see” for too long: If the disease is progressing toward collapse, waiting too long can turn a “saveable” Stage IIIA wrist into a “salvage” Stage IV wrist [21][22].
  3. Does not mention staging: Any treatment plan must be based on a clear understanding of your Lichtman Stage. If your doctor hasn’t discussed your stage, they may not be following established protocols [1].
  4. Not a Specialist: Because this disease is complex, you should seek out a fellowship-trained orthopedic hand surgeon for your care.

Common questions in this guide

How does my Lichtman stage affect my Kienböck disease treatment?
Your Lichtman stage determines whether the focus is on saving the lunate bone or managing wrist stability. Early stages often use bone grafts or joint-leveling to preserve the bone, while later stages rely on fusion or removal to stop arthritis pain.
What is a radial shortening osteotomy?
This is a joint-leveling surgery where a few millimeters of the radius arm bone are removed. It helps shift pressure away from the damaged lunate bone in the wrist, giving it a better chance to recover and heal.
When is a Proximal Row Carpectomy (PRC) recommended?
A PRC is a late-stage salvage procedure used when arthritis has spread across the wrist. It involves removing the first row of wrist bones, including the lunate, to provide long-term pain relief while preserving some wrist movement.
Can Kienböck disease be treated without surgery?
In the very earliest stages before bone collapse occurs, rest and a rigid wrist splint may be used to manage pain and protect the joint. However, once the lunate bone begins to collapse, surgical intervention is typically necessary to prevent further instability.
Why is an MRI necessary for Kienböck disease instead of just an X-ray?
An MRI is required because early-stage Kienböck disease often looks completely normal on a standard X-ray. If you wait until the damage is visible on an X-ray, the bone may have already started to collapse, limiting your treatment options.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Based on my Lichtman stage, should we be focusing on 'unloading' the bone or 'rebuilding' its blood supply?
  2. 2.If we choose a joint-leveling surgery (radial shortening), how many millimeters do you plan to remove, and how will that affect my long-term grip strength?
  3. 3.Am I a candidate for a vascularized bone graft to restore blood flow to the lunate?
  4. 4.Why are you recommending a salvage procedure like a PRC versus a limited fusion like scaphocapitate arthrodesis?
  5. 5.How many Kienböck-specific surgeries do you perform each year, and what are your typical patient outcomes at my stage?
  6. 6.If we try conservative treatment (splinting), what is our exact timeline for 're-evaluating' with an MRI to ensure it isn't progressing?

Questions For You

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References

References (22)
  1. 1

    The Role of Wrist Arthroscopy in Kienbock Disease.

    MacLean SBM, Kantar K, Bain GI, Lichtman DM

    Hand clinics 2017; (33(4)):727-734 doi:10.1016/j.hcl.2017.07.003.

    PMID: 28991584
  2. 2

    Kienböck Disease and Arthroscopy: Assessment, Classification, and Treatment.

    Bain GI, MacLean SB, Tse WL, et al.

    Journal of wrist surgery 2016; (5(4)):255-260 doi:10.1055/s-0036-1584546.

    PMID: 27777814
  3. 3

    Kienböck's disease: preventing disease progression in early-stage disease.

    Salva-Coll G, Esplugas M, Carreño A, Lluch-Bergada A

    The Journal of hand surgery, European volume 2023; (48(3)):246-256 doi:10.1177/17531934221146851.

    PMID: 36799262
  4. 4

    Is Joint Levelling Procedure Better than Temporary Scaphocapitate Pinning in Patients Undergoing Vascularized Bone Graft for Kienböck Disease?

    Jung HS, Lee HW, Park MJ

    The journal of hand surgery Asian-Pacific volume 2019; (24(4)):428-434 doi:10.1142/S2424835519500541.

    PMID: 31690195
  5. 5

    Clinical Outcomes of Patients with Stage II and IIIA Kienböck's Disease After Undergoing Conservative Management.

    Lee JH, Son J, Park MJ

    Indian journal of orthopaedics 2022; (56(1)):79-86 doi:10.1007/s43465-021-00451-0.

    PMID: 35070146
  6. 6

    Functional and Radiographic Disease Progression in Nonoperatively Managed Kienböck Disease.

    DeGeorge BR, Chawla SS, Lewallen L, Kakar S

    Plastic and reconstructive surgery 2021; (147(5)):1117-1123 doi:10.1097/PRS.0000000000007838.

    PMID: 33890893
  7. 7

    Functional Outcomes after Radial Shortening Osteotomy in Stage IIIA Kienböck's Disease: A Five-Patient Case Series.

    Kumar P, Durrani S, Tiwari A, et al.

    Journal of orthopaedic case reports 2026; (16(2)):328-334 doi:10.13107/jocr.2026.v16.i02.6842.

    PMID: 41669014
  8. 8

    Risk Factors of Lunate Collapse in Kienböck Disease.

    van Leeuwen WF, Tarabochia MA, Schuurman AH, et al.

    The Journal of hand surgery 2017; (42(11)):883-888.e1 doi:10.1016/j.jhsa.2017.06.107.

    PMID: 28888572
  9. 9

    Capitate shortening osteotomy and vascularized bone grafting for Kienböck's disease in ulnar positive or neutral wrists.

    Hunter AR, Temperley D, Trail IA

    The Journal of hand surgery, European volume 2021; (46(6)):581-586 doi:10.1177/1753193421999915.

    PMID: 33752485
  10. 10

    A novel classification of Kienbock's disease based on magnetic resonance imaging.

    Bae JY, Shin YH, Choi SW, et al.

    International orthopaedics 2023; (47(8)):2023-2030 doi:10.1007/s00264-023-05861-3.

    PMID: 37300563
  11. 11

    Kienböck's Disease - A Case Report: Treatment of Two Advanced Cases.

    Rocha DDS, Willame D, Postlethwaite D, Deschuyffeleer S

    Journal of orthopaedic case reports 2025; (15(11)):30-36 doi:10.13107/jocr.2025.v15.i11.6296.

    PMID: 41281835
  12. 12

    Arthroscopic scaphocapitate fusion without bone graft; clinical and radiological outcomes.

    Ghoneim S, Kamal R, Semaya A, Hasan M

    International orthopaedics 2025; (49(2)):467-474 doi:10.1007/s00264-024-06381-4.

    PMID: 39581946
  13. 13

    Prospective comparative study of scaphocapitate arthrodesis with and without lunate excision for stage IIIB Kienböck's disease.

    Hegazy G, Seddik M, El-Sadek R, et al.

    Archives of orthopaedic and trauma surgery 2025; (146(1)):12 doi:10.1007/s00402-025-06147-6.

    PMID: 41410869
  14. 14

    Dorsolateral Biplane Closing Radial Osteotomy and Lunate Fixation for Stage IIIC Kienböck Disease: A New Surgical Approach.

    Barrera-Ochoa S, Campillo-Recio D, Muñoz-Perdomo T, et al.

    Techniques in hand & upper extremity surgery 2018; (22(3)):74-80 doi:10.1097/BTH.0000000000000197.

    PMID: 29894391
  15. 15

    Vascularized Bone Flaps for the Treatment of Kienböck Disease.

    Florczynski MM, Chung KC

    Hand clinics 2022; (38(4)):435-446 doi:10.1016/j.hcl.2022.03.007.

    PMID: 36244711
  16. 16

    [Etiology, diagnostics and classification of lunate bone necrosis].

    Lögters T, Büren C, Windolf J

    Der Unfallchirurg 2018; (121(5)):373-380 doi:10.1007/s00113-018-0495-6.

    PMID: 29644422
  17. 17

    A Comprehensive Case Report on Kienbock's Disease: Diagnostic Hurdles and Surgical Outcomes With Proximal Row Carpectomy.

    Elamurugan A, Nirenjen S, Manivannan AG, et al.

    Cureus 2024; (16(8)):e66829 doi:10.7759/cureus.66829.

    PMID: 39280429
  18. 18

    [Proximal Row Carpectomy - Five-Year Results].

    Švarc A, Pilný J, Repko M, et al.

    Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca 2018; (85(2)):120-124.

    PMID: 30295598
  19. 19

    Delayed Avascular Necrosis and Fragmentation of the Lunate Following Perilunate Dislocation.

    Wilke B, Kakar S

    Orthopedics 2015; (38(6)):e539-42 doi:10.3928/01477447-20150603-92.

    PMID: 26091230
  20. 20

    Simplifying the Decision-Making Process in the Treatment of Kienböck's Disease.

    Tee R, Butler S, Ek ET, Tham SK

    Journal of wrist surgery 2024; (13(4)):294-301 doi:10.1055/s-0043-1778064.

    PMID: 39027019
  21. 21

    Pathophysiology of Avascular Necrosis.

    Wells ME, Dunn JC

    Hand clinics 2022; (38(4)):367-376 doi:10.1016/j.hcl.2022.03.011.

    PMID: 36244704
  22. 22

    Coexisting Kienböck's and Preiser's Disease of the Wrist: Experience with Proximal Row Carpectomy with Dorsal Capsular Interposition Technique.

    Oh S, Park HW, Kang SH, et al.

    Orthopaedic surgery 2023; (15(9)):2477-2481 doi:10.1111/os.13776.

    PMID: 37345451

This page provides educational information about surgical and conservative treatments for Kienböck disease. Always consult a fellowship-trained hand surgeon for a treatment plan based on your specific Lichtman stage.

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