PurposeThis study aims to compare results after open lunate excision alone and in combination with palmaris longus tendon ball arthroplasty for the treatment of late-staged Kienböck’s disease (KD).MethodsThis is a retrospective study using the prospectively collected data, and patients who had a discharge diagnosis of KD (stage IIIB based on Lichtman staging criteria) and underwent surgical treatment by lunate excision alone or in combination with palmaris longus tendon ball arthroplasty between January 2011 and December 2020 were included in this study. Variables of interest involved demographics, disease condition, operative procedure, and the outcomes evaluated at the last follow-up. Within and between comparisons were performed.ResultsThirty-five patients underwent lunate excision alone, and 40 patients underwent the combination procedure. At the final follow-up, patients in both groups exhibited significant improvements compared to pre-operation, such as wrist flexion, wrist extension, carpal height ratio, PRWE score, Cooney score, and grip strength (allP< 0.05). Compared to the excision group, combination procedure group had significantly longer surgical time (P< 0.001), more blood loss (P< 0.001) and exhibited better wrist flexion (P= 0.001), PRWE score (P= 0.001), Cooney score (P= 0.0034), and grip strength (P= 0.017). The excellent or good rate based on Cooney wrist score was not significantly different (87.5% vs 71.4%,P= 0.083).ConclusionLunate excision in combination with palmaris longus tendon ball arthroplasty is a better option than lunate excision alone for the treatment of stage III KD and can be considered as an operative option.