Systems, devices, and methods are provided for aligning acetabular implants. A patient-matched acetabular alignment tool is used to orient tools and implants intraoperatively. The patient-matched acetabular alignment tool includes a mounting member and leg members which are configured based on the particular patient's anatomic landmark sites (e.g., acetabular bony landmarks). The leg members are attached to the mounting member and configured to connect with a respective anatomic landmark site to achieve a desired implant angle and axis. For example, the leg members may form a tripod support base through which an acetabular shell may be inserted into the patient's acetabulum at desired angles of version and inclination. In some embodiments, the leg members may be retractable and expandable with respect to the mounting member, thereby providing a tool with reduced profile for inserting the device in the patient's soft tissue.