Background: This study evaluated the long-term (>5 y) outcomes of radial shortening osteotomy and vascularized bone graft in Kienböck disease patients. Methods: In a retrospective study of 16 patients with early stage Kienböck disease, 9 patients with average follow-up of 6.4 years had radial shortening osteotomy (group 1), and 7 with average follow-up of 6.5 years had pedicled vascularized bone graft (group 2). The 2 groups were similar in age, sex, operated side, initial Lichtman stage, and follow-up duration. There were significant differences in ulnar variance between the 2 groups. At the last follow-up, the patients were evaluated for pain, wrist motion, grip strength, functional status, and radiographic assessment. The overall results were evaluated by Cooney wrist function score and Nakamura scoring system for Kienböck disease. Results: The 2 groups had no significant difference in pain, motion, grip strength, and radiologic assessment however, grip strength percentage was better in group 2. There was no significant difference between the radiographic changes of the 2 groups. In group I, 7 patients had satisfactory Nakamura scores, and 5 patients had satisfactory Cooney scores. All of the patients in group 2 had satisfactory Cooney and Nakamura scores.The difference in the mean Cooney wrist function score in the 2 groups was significant. The difference of Nakamura scores in the 2 groups was not significant. Conclusions: Both groups had reasonable long-term outcomes. We were unable to recognize a substantial clinical or radiological difference between the 2 surgical treatments in long-term outcome.