The ROBODOC system has provided better fit and fill of the stem and less destruction of the bony architecture than with manual surgery. These benefits might affect femoral periprosthetic bone remodeling. We evaluated the effects of robotic milling in cementless total hip arthroplasty (THA) in a longitudinal 24-month follow-up study using dual energy X-ray absorptiometry (DEXA) and plain radiographs of 29 patients (31 hips) after ROBODOC THA and 24 patients (27 hips) after manual THA with the same stem design. To minimize the influence of other factors on bone remodeling, only female osteoarthritis patients, who had no drugs that might affect bone metabolism were enrolled. Significantly less bone loss occurred at the proximal periprosthetic areas in the ROBODOC group. In zone 1, the decrease was 15.5 versus 29.9% using conventional rasping; in zone 7, the loss was 17.0% with ROBODOC compared to 30.5% with conventional rasping (p < 0.05). On radiographs, endosteal spot welds in the proximal medial portion were more pronounced in the ROBODOC group (48 vs. 11% in the conventional group, p < 0.05). Our results suggest that robotic milling is effective in facilitating proximal load transfer around the femoral component and minimizing bone loss after cementless THA.