Introduction We report three patients with KienboeckÕs disease, which had developed from stage 3a to 3b despite osteotomy of the radius, who were treated successfully by vascularized radial bone engraftment to the lunate combined with capitate shortening. Patients & Methods The patients were two females and one male with stage 3a KienboeckÕs disease. One with the ulna-minus variant underwent radial shortening and two underwent closed radial osteotomy. Since none of them were relieved of wrist pain 5-12 months after the first operation, they underwent a second operation. The mean age of the patients at the time of the second operation was 33 years. The capitate was shortened to reduce the axial load on the lunate and to provide space for increasing the lunate height. Necrotic bone was removed from the lunate, leaving the cartilage, a small piece of subchondral bone and the interosseous ligament in the lunate. After correcting the height of the lunate, a piece of vascularized bone harvested from the dorsal aspect of the distal radus was inserted into the lunate. Results After the second operation, no patients complained of wrist pain, and the grip strength of the affected wrist recovered to 47-71% that of the normal opposite wrist. The motion of the treated wrist was 60-83% normal in dorsiflexion and 16-38% normal in volar flexion. StahlÕs index was markedly increased, while the carpal height ratio remained unchanged. The scapholunate angle decreased to the normal range in all cases. All three patients returned to their previous job within 8 months after the second operation. Discussion and Conclusions Engraftment of a vascularized bone fragment combined with shortening of the capitate provided a satisfactory outcome in patients with KienboeckÕs disease, who had undergone previous radial osteotomy, although volar flexion arc of the wrist joint was restricted. These cases indicate that vascularized bone engraftment to the lunate combined with capitate shortening can be employed for treatment of advanced KienboeckÕs disease.