The ninth seeded Russian stepped up his game after losing the first set and took the victory 3-6 6-3 6-3.
“I was so tired in the first set and playing Novak, I thought I’m not going to be able to keep the intensity,” Medvedev said in a courtside interview with ESPN.
“Then there was one momentum change in the second and I just started playing unbelievable.”
Medvedev, who also beat Djokovic in April at Monte Carlo, will play Belgian David Goffin in the final on Sunday.
The 16th seeded Goffin beat France’s Richard Gasquet 6-3 6-4 in the other semi-final.
“I’m really happy,” said Goffin. “I’ve played the best tennis here in the past few years... It’s a great moment for me.”
A quick break saw Goffin surge to a 4-1 lead with a backhand winner down the line in the first set.
Gasquet grabbed a 2-0 lead in the second set before Goffin claimed five of the next six games.
He won the set and the match when a Gasquet backhand was long.
Goffin had received a walkover into the semi-finals after Yoshihito Nishioka was forced to withdraw due to food poisoning.
“It was almost a day off, so I was fresh and physically 100% today to play against Richard,” the Belgian said.
Barty stunned by Kuznetsova
In the women’s side, Ash Barty stunningly lost her chance to regain the number one world ranking when the Australian was beaten in straight sets by Russian Svetlana Kuznetsova in the semi-finals the same day.
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Aug 17, 2019; Mason, OH, USA; Svetlana Kuznetsova (RUS) reacts against Ashleigh Barty (AUS) during the Western and Southern Open tennis tournament at Lindner Family Tennis Center. Mandatory Credit: Aaron Doster-USA TODAY Sports
Top seed Barty, who would have replaced the injured Naomi Osaka as the world number one with a victory, struggled with the rhythm off her serve as she lost 6-2 6-4, losing eight consecutive games to the Russian at one point.
Kuznetsova, ranked world number 153, will play American Madison Keys for the title on Sunday.
Keys, the 16th seed, turned back compatriot Sofia Kenin 7-5 6-4 in their semi-final.
She entered the Cincinnati tournament as a wild card after winning two matches in Toronto. Issues in obtaining a US visa kept her from defending her Washington DC title.
Barty won the first two games, then lost the set as Kuznetsova, handling the Australian’s slices effectively and serving well, won the next six.
Barty at one point called a medical time-out to have her right ankle retaped.
But the streak continued in the second set, with Kuznetsova winning the opening two games before Barty held.
The Australian rallied to 4-3 and 5-4 before Kuznetsova served out the victory.
Keys had 41 winners, fired 14 aces and won 80% of her first serves to make her first hardcourt final in two years.
The 2017 US Open finalist raced to a 5-2 lead in the first set before Kenin saved a set point and won three games in a row to level things at 5-5.
Keys then took the set by winning the next two games.
She fell a break down twice in the second set, but rallied to win the last three games to claim the match.
