Kienböck disease, or osteonecrosis of the lunate, most often affects patients between the ages of 20 and 40 years. There are 4 major stages of the disease, and treatment is based on the stage of disease. Advancements are still being made with regards to the cause, pathophysiology, and preferred method of treatment of each stage. Although the goals of pain relief, motion preservation, strength maintenance, and function outcomes are paramount to success, no 1 procedure consistently and reliably achieves these outcomes. Further advancements in treatment and results of long-term outcome studies should resolve some of these topics.