Methods and apparatus provide for modifying a patients femur to receive a patellofemoral prosthesis, including: a distal punch, an anterior punch and a trochlear punch 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 operating to engage a distal end of the femur, the guide including a distal slot, an anterior slot and a transverse slot, which ensure that the punches achieve the desired orientations.
