We evaluated the effects of conventional hand rasping and robotic milling on the clinical and radiographic results of cementless total hip arthroplasty, with the same computed tomography (CT)-based 3-dimensional preoperative planning using a ROBODOC workstation (Integrated Surgical Systems, Davis, Calif). The robotic milling group consisted of 78 hips, and the hand-rasping group 78 hips. The radiographic findings from the preoperative planning and postoperative CT data were evaluated using the most accurate CT images reconstructed by the ROBODOC workstation. The robotic milling group showed significant superior Merle D'Aubigne hip score at 2 years. In the robotic milling group, there were no intraoperative femoral fractures, and a radiographically superior implant fit was obtained. Hand rasping had the potential to cause intraoperative femoral fractures, undersizing of the stem, unexpectedly higher vertical seating, and unexpected femoral anteversion causing inferior implant fit.