We investigated the results of 53 patients in a retrospective study after surgical treatment for Kienböck's disease. Surgery included shortening of the radius (35 cases), cancellous bone graft (four cases), pisiform transposition (two cases), Swanson prostheses (two cases), tendon interposition arthroplasty (one case), STT-arthrodesis (six cases), denervation of the wrist (one case), and wrist arthrodesis (two cases). The average follow-up was 43 months (minimum 12, maximum 84 months). Criteria for rating the results were subjective satisfaction and pain profile. Objective criteria were X-ray findings and range of motion of the hand and wrist. We paid particular attention to the economic consequences for the patients. Based on our own results and the results in the literature, we recommend bone-grafting in the early Decoulx stages I and II. In stages II and III, we recommend in cases of ulna-minus variance the shortening of the radius in combination with a bone grafting; in case of an ulna-zero variance, we have the possibility of a radius wedge osteotomy or a pisiform transposition. Stage III, especially IIIb according to Lichtman, is suitable for STT-arthrodesis. In stage IV, we recommend total wrist arthrodesis, the denervation of the wrist can be combined with all the other methods or as a salvage procedure prior to wrist arthrodesis.