We investigate the possibility of spin-preserving symmetries due to the interplay of Rashba and Dresselhaus spin-orbit coupling in n-doped zinc-blende semiconductor quantum wells of general crystal orientation. It is shown that a conserved spin operator can be realized if and only if at least two growth direction Miller indices agree in modulus. The according spin-orbit field has in general both in-plane and out-of-plane components and is always perpendicular to the shift vector of the corresponding persistent spin helix. We also analyze higher-order effects arising from the Dresselhaus term, and the impact of our results on weak (anti)localization corrections.