Apparatus and methods are disclosed for preparing the rejected posterior surface of a patella to receive a prosthetic element. Though applicable to both primary arthroplasty, the invention is ideally suited to revision procedures wherein the patella has previously failed or may be damaged or otherwise compromised. The method includes the steps of applying a layer of material which hardens on the posterior surface of the patella, and urging an inventive die having a planar surface against the layer of material before it hardens so as to create a reconstructed surface which serves as a host for a prosthesis. The preferred hardening material is polymethylmethacrylate (PMMA) due to the widespread use of PMMA as a cement in conjunction with orthopaedic techniques. To provide a thicker build-up, however, the die surface may be recessed relative to a peripheral edge, so that the reconstructed surface is raised relative to the posterior surface of the patella. The reconstructed surface may then be further prepared or used directly as a host for the prosthetic element. Various articles may also be embedded into the hardening material to strengthen the reconstruction or provide attachment mechanisms. As examples, a mesh may be embedded within the material prior to hardening, or one or more cables may be added to engage with tendons attached to the patella.