Conservatively casting and splinting can be tried. In negative ulnar variance, the radialulnar joint can be leveled by radial shortening or ulnar lengthening, which in theory, unloads the lunate and redistributes the load to the scaphoid. In the level joint, a radial wedge osteotomy, STT fusion, capitate shortening with capitate hamate fusion (there are others as well) can be attempted. These procedures are done in the hope that by relieving some pressure from the lunate, it can recover and revascularize on it's own, or at least the disease process is stopped.

More recently, a direct attempt at revascularization is made by taking cancellous bone (soft bone), with it's own blood supply, from the radius and plugging it into the lunate (the necrotic, diseased bone having been drilled out) - aka a vascularized bone graft. A VBG can also be done concurrently with a joint leveling procedure.

The second category of treatment would be the salvage procedures, proximal row carpectomy, full fusion, and an array of partial fusions. The idea being that the lunate cannot be "saved" and these procedures are done to relieve pain and restore some sort of function to the hand and wrist.

The procedures available for the treatment of Kienbock's Disease are entirely dependent upon the stage of the disease and the etiological factors involved. There is no definitive answer, your path will be unique, the route you choose will depend on your desires and activity level, the stage of disease, and the experience of your surgeon.

with thanks to Phyllis Walker

See also: Kienbock's Disease: Diagnosis and Treatment --Allan CH, Joshi A, Lichtman DM.

Denervation

Equalization\Unloading

Capitate Recession

Radial Shortening

Radial Wedge Osteotomy

Ulna Lengthening

Lunate Excision

Pisiform Implant

Proximal Row Carpectomy, or PRC

Proximal Row Carpectomy With Capitate Recession

Rolled Tendon Graft (different tendons have been used)

Silicone Implant

Simple Excision

Titanium Implant

Metaphyseal Core Decompression, or MCD

Partial, or Limited Intercarpal Fusion

Capitohamate Fusion

Scaphocapitate Fusion

Scaphoid, Trapezoid, Trapezoid Fusion, STT

Triscaphe Fusion

Revascularization

Direct Transplantation of Vascular Bundle

Vascularized bone Graft From the Index Metacarpal

Vascularized Bone Graft Using Pedicle Graft From Pisiform

Vascularized Bone Graft Using Pedicle Graft From Radius

Total Wrist Arthrodesis

Total Wrist Replacement