Disclosed herein are systems, devices, and methods for guiding placement, orientation, and fixation of an orthopedic implant. Examples include a surgical guide having a first surface structured to fit within a prosthetic cup, at least one guide hole through the first surface, and an alignment structure having a contour formed from data indicative of the patient anatomy. The contour of the alignment surface is complementary to a portion of the patient anatomy in a unique orientation that aligns the guide hole with tissue suitable for receiving a fastener. The alignment structure preferably includes an arm with a first end coupled to a rim of the guide and a second end coupled to the contour. In certain implementations, the guide includes a plurality of alignment structures. Further disclosed are methods of making and using a surgical guide for aligning an orthopedic implant.