Abstract: A patella recession instrument (10) and method provides a guide for producing an oval, tri-oval, or elliptically shaped recess on the posterior surface of the osteotomized patella for receiving a similarly shaped backing portion of a patellar implant. The apparatus includes a guide bushing (12) and a bushing positioning mechanism (14) for securing the bushing against the posterior of the osteotomized patella, with a guide opening (54) formed through the bushing covering the total area to be recessed. A reamer guide structure, which may be a separate structure (16) received in the bushing guide opening (54) or integrally formed with the bushing (12), receives one or more rotary reamer tools (18) in a plurality of reaming positions. The cutting face (80) of the rotary reamer tool (18) in each different reaming position covers a different portion of the total area to be recessed.