Bone is dynamic, highly vascularised tissue with a unique capacity to heal?and remodel. Its main role is to provide structural support for the body. Furthermore the skeleton also serves as a mineral reservoir, supports muscular contraction resulting in motion, withstands load bearing and protects internal organs . Hence, it is logical to say that major alterations in its structure due to injury or disease can dramatically alter one?s body equilibrium and quality of life. There are roughly 1 million cases of skeletal defects a year that require bone-graft procedures to achieve repair. Socioeconomic consequences in treating these patients with bone fractures is a major concern in both the USA and EU, which are likely to increase due to the ageing of their populations. Bone repair may be treated by grafts taken from either the patient?s own existing bone from other sites (autografts) or donor sources (allografts). The use of synthetic substitutes eliminates the need for further surgery for autografts and the risk of infectious disease transmission from allografts. The significant limitations of current treatments have compelled researchers to develop synthetic alternatives for bone reconstruction. In the early 1950s Swedish orthopaedic surgeon Per Ingvar Branemark began studying the healing process of titanium anchoring screws, which proved to be a seminal point for modern dental and orthopaedic implants . Current bone substitutes using metal, ceramic, polymer and composites, though far from ideal, are commonly implanted materials, second only to blood products. Currently, bone tissue engineering is being researched including scaffolds, growth factors and engineering cells which may provide next-generation bone substitutes. Production of such bone implants and scaffolds requires complex structures that would provide the necessary bone shape and morphology. In general, current orthopaedic prostheses are modular in nature and, although scalable, adhere to a range of basic generic designs. The surgeon, therefore, must select the best size fit based upon preoperative evaluation of radiographs. Current production methods for these devices, which are made from metal/ceramic/ polymers, include casting, compression moulding, sintering, and bar stock milling. These approaches have some inherent restrictions, these include the use of static moulds/tooling which do not allow rapid design changes or one-off patient-specific devices to be produced, or they have geometry restrictions, and high material wastage. One school of thought believes that patient-oriented devices have the potential to enhance the longevity of a device by providing a securer fit, especially in those cases where the devices are not cemented. Closeness of fit aims to aid the distribution and normalization of the stresses incurred in the remaining skeletal system, thereby reducing stress shielding, micromotion, and sinkage. Accurate fits are typically achieved by removing the patient?s bone stock to accommodate the prosthesis, thereby destroying valuable viable bone and making any revision surgery more difficult. It would be preferable to produce custom prostheses for individual patients that required little or no healthy bone stock removal to increase the device stability, especially in young patients, and thus increase the options for a successful revision surgery if required . Today reverse engineering (RE) and medical image-based modelling technologies allow the construction of three-dimensional (3D) models of anatomical structures of human body based on information from imaging data such as computerized tomography (CT), magnetic resonance imaging (MRI), and laser (or structured light) scanning . Based on 3D models, advanced mouldless manufacturing techniques, commonly known as solid free-from fabrication (SFF) or rapid prototyping (RP) have been used to build 3D physical models for surgical training, preoperative planning, surgical simulation andmore recently applied to fabricate customised implants and scaffolds for individual patients. This chapter gives a background on bone structure and properties, biomaterials for bone implants and requirements for bone implant and scaffolds. It then introduces state-of-the-art reverse engineering and rapid prototyping techniques to assist in the manufacture of customised bone implants and then focuses on current research on the techniques to fabricate bone implants and scaffolds directly.