Methods and apparatus provide for modifying a patients femur to receive a patellofemoral prosthesis, including: a distal punch (104), an anterior punch (106) and a trochlear punch (108) which are used in well defined orientations to remove material from the femur to accommodate complex geometries of a patellofemoral prosthesis and optionally a guide (102) operating to engage a distal end of the femur, the guide including a distal slot (116), an anterior slot (114) and a transverse slot (112), which ensure that the punches achieve the desired orientations.
