Described herein are systems and methods for creating a custom registration guide. In general, the methods may include receiving scan data of a patients bone creating instructions based on the scan data for creating a three-dimensional surface model of the patients bone and moving a plurality of moveable elements, coupled to the adjustable model, based on the instructions. The method may further include the steps of placing a malleable registration guide onto the adjustable model and shaping the registration guide to fit to the adjustable model. The method may further include the step of intraoperatively determining the location of a patients bone using the custom registration guide. The step of determining the location of the patients bone may include the steps of coupling the registration guide and fiducial markers to the patients bone.
