If immobilizing the wrist doesn’t help, then surgery will probably be required. Attempts to restore the blood flow to the lunate are most likely to be successful at this point. The procedure to restore blood flow is called revascularization. During the operation, the surgeon moves a small section of blood vessels (and also possibly bone) from elsewhere on the patient. The segment is attached to the deteriorating lunate bone. This is done to restore blood flow to the lunate and halt its deterioration. This is a newer procedure to treat Kienbock’s disease and is not always successful.
Other treatment options at this stage include operations designed to take some of the pressure off the lunate bone. Doing this may allow the bone to heal and revascularize – or it may slow the progression of the disease. Operations to do this include a radial shortening osteotomy. In this operation, removing a small section of the bone near the wrist shortens the radius bone, allowing the bone to heal together in this shortened position. Some surgeons prefer a capitate shortening (known as the Almquist procedure) which shortens a carpal bone on the other side of the lunate. Both operations help reduce the force on the lunate.