Nakamura competed in his first match since SummerSlam on the September 11 episode of "SmackDown Live", losing to Jeff Hardy via disqualification after interference from Randy Orton. After refusing to defend the WWE United States Championship at the Hell in a Cell pay-per-view, general manager Paige ordered Nakamura to defend the Championship on the September 18 episode of "SmackDown Live", which he did so successfully, defeating Rusev. At SmackDown 1000, Nakamura lost to the returning Rey Mysterio in a qualifying match for the WWE World Cup at Crown Jewel. Nakamura would successfully retain the title on the October 30 episode of "SmackDown Live" against R-Truth and then against Rusev at Crown Jewel. Nakamura lost to Raw's WWE Intercontinental Champion Seth Rollins in an interbrand Champion vs Champion match at Survivor Series. On the December 25 episode of "SmackDown Live" (taped on December 18), Nakamura lost the WWE United States Championship to Rusev, ending his reign at 156 days. On January 27, 2019, at the Royal Rumble, Nakamura defeated Rusev to win his second WWE United States Championship. Later that night, he participated in the Royal Rumble match entering at #3 but was eliminated by Mustafa Ali.