Objective.To assess reliability, feasibility, and responsiveness of Hip Inflammation Magnetic resonance imaging Scoring System (HIMRISS) for bone marrow lesions (BML) in hip osteoarthritis (OA).Methods.HIMRISS was scored by 8 readers in 360 hips of 90 patients imaged pre/post-hip steroid injection. Pre-scoring, new readers trained online to achieve intraclass correlation coefficient (ICC) > 0.80 versus experts.Results.HIMRISS reliability was excellent for BML status (ICC 0.83–0.92). Despite small changes post-injection, reliability of BML change scores was high in femur (0.76–0.81) and moderate in acetabulum (0.42–0.56).Conclusion.HIMRISS should be a priority for further assessment of hip BML in OA, and evaluated for use in other arthropathies.