In many biomedical applications, it is desirable to estimate the three-dimensional (3D) position and orientation (pose) of a metallic rigid object (such as a knee or hip implant) from its projection in a two-dimensional (2D) X-ray image. If the geometry of the object is known, as well as the details of the image formation process, then the pose of the object with respect to the sensor can be determined. A common method for 3D-to-2D registration is to first segment the silhouette contour from the X-ray image; that is, identify all points in the image that belong to the 2D silhouette and not to the background. This segmentation step is then followed by a search for the 3D pose that will best match the observed contour with a predicted contour. Although the silhouette of a metallic object is often clearly visible in an X-ray image, adjacent tissue and occlusions can make the exact location of the silhouette contour difficult to determine in places. Occlusion can occur when another object (such as another implant component) partially blocks the view of the object of interest. In this paper, we argue that common methods for segmentation can produce errors in the location of the 2D contour, and hence errors in the resulting 3D estimate of the pose. We show, on a typical fluoroscopy image of a knee implant component, that interactive and automatic methods for segmentation result in segmented contours that vary significantly. We show how the variability in the 2D contours (quantified by two different metrics) corresponds to variability in the 3D poses. Finally, we illustrate how traditional segmentation methods can fail completely in the (not uncommon) cases of images with occlusion.