Illustrative methods and systems for customizing a pre-manufactured acetabular shell to a specific patient are described herein. An illustrative method can include positioning a provisional shell at an acetabulum of the patient, the provisional shell having a plurality of selectable openings. The method further including marking, based on the assessing of the bone, a patient-matched hole location on a provisional liner that corresponds to one of the plurality of selectable openings in the provisional shell. With the provisional liner marked, the method can further include removing the provisional liner from the provisional shell and positioning the provisional liner in the pre-manufactured acetabular shell that is to be implanted in the patient. Using the provisional liner as a guide, the method can include forming a hole in the acetabular shell corresponding to the marked patient-matched hole location on the provisional liner.